Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye
Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye
复制标题
DOI：
10.1245/s10434-011-1689-0
复制
发表时间：
2011-10-01
影响因子：
3.7
通讯作者：
Leong, Stanley P. L.
中科院分区：
文献类型：
--
作者：
Liu, Liang-Chih;Parrett, Brian M.;Leong, Stanley P. L.
背景。确定黑色素瘤应切除多少前哨淋巴结 (SLN) 很重要。本研究的目的是确定比“最热”节点（呈阴性）放射性较低的节点对黑色素瘤呈阳性的频率、应保证收获的放射性有多低，以及是否需要异硫丹蓝。方法。我们回顾了 1,152 名黑色素瘤患者，这些患者从 1996 年到 2008 年接受了锝淋巴闪烁显像（有或没有蓝色染料）和 SLN 解剖。放射性为千分之一的 SLN 是“最热”SLN 的 10%，所有蓝色节点和所有可疑节点均被切除并分析。漏检率计算为“最热”SLN 为阴性的节点阳性病例的比例。结果。在 1,152 名患者的 1,520 个淋巴结盆地中发现了 SLN。在 204 名患者 (18%) 的 218 个盆地 (14%) 中检测到 SLN 微转移。在 16% 的 SLN 阳性患者（33/204 名患者）中，发现阳性 SLN 的放射性计数低于“最热”SLN（阴性）。在其中 21 个病例中，阳性 SLN 的放射性为“最热”SLN 的 50%。与仅删除“最热”SLN（缺失率 = 16%）相比，10% 规则将缺失率显着降低至 2.5%。此外，与使用 10% 规则的单独放射性胶体相比，蓝色染料并未显着降低漏检率。结论。为了降低漏检率，所有 SLN 的离体放射性为“最热”SLN 的 10%，并且蓝色染料不是必需的。
Background. Determining how many sentinel lymph nodes (SLNs) should be removed for melanoma is important. The purpose of this study is to determine the frequency at which nodes that are less radioactive than the "hottest" node (which is negative) are positive for melanoma, how low of a radioactivity should warrant harvest, and if isosulfan blue is necessary.Methods. We reviewed 1,152 melanoma patients who underwent lymphoscintigraphy with technetium, with or without blue dye, and SLN dissection from 1996 to 2008. SLNs with radioactivity a parts per thousand yen10% of the "hottest" SLN, all blue nodes, and all suspicious nodes were removed and analyzed. The miss rate was calculated as the proportion of node positive cases in which the "hottest" SLN was negative.Results. SLNs were identified in 1,520 nodal basins in 1,152 patients. SLN micrometastases were detected in 218 basins (14%) in 204 patients (18%). In 16% of SLN-positive patients (33/204 patients), the positive SLN was found to have a lower radioactive count than the "hottest" SLN, which was negative. In 21 of these cases, the positive SLNs had radioactivity a parts per thousand currency sign50% of the "hottest" SLN. The 10% rule significantly reduced the miss rate to 2.5% compared with removal of only the "hottest" SLN (miss rate = 16%). Also, blue dye did not significantly decrease the miss rate compared with radiocolloid alone using the 10% rule.Conclusions. To decrease the miss rate, all SLNs with a parts per thousand yen10% of the ex vivo radioactivity of the "hottest" SLN should be removed and blue dye is not essential.