Technical details of intraoperative lymphatic mapping for early stage melanoma.
Technical details of intraoperative lymphatic mapping for early stage melanoma.
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DOI：
10.1001/archsurg.1992.01420040034005
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发表时间：
1992-04
影响因子：
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通讯作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran
中科院分区：
文献类型：
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作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran
大多数黑色素瘤患者转移的最初途径是通过淋巴结转移到区域淋巴结。然而，临床I期黑色素瘤患者的常规淋巴结切除术仍有争议，因为这些患者中的大多数没有淋巴结转移，不太可能从手术中受益，并可能遭受麻烦的术后四肢水肿。开发了一种新的程序，使用活体染料，允许术中识别前哨淋巴结，淋巴结最接近的原发性黑色素瘤的网站，在直接引流途径。前哨淋巴结是最可能的早期转移部位，可以立即切除，以进行术中研究，以确定临床上隐匿的黑色素瘤细胞。我们在237个淋巴池中的194个中成功识别了前哨淋巴结，并在常规苏木精-伊红染色切片（12%）或完全化学染色标本（9%）检查中检测到40个标本（21%）中的转移。259个前哨淋巴结中有47个（18%）存在转移，而194个淋巴结切除标本中有可识别的前哨淋巴结的3079个淋巴结中只有2个非前哨淋巴结是唯一的转移部位，假阴性率小于1%。因此，该技术以高度的准确性识别具有淋巴结转移并且可能受益于根治性淋巴结切除术的早期黑素瘤患者。
The initial route of metastases in most patients with melanoma is via the lymphatics to the regional nodes. However, routine lymphadenectomy for patients with clinical stage I melanoma remains controversial because most of these patients do not have nodal metastases, are unlikely to benefit from the operation, and may suffer troublesome postoperative edema of the limbs. A new procedure was developed using vital dyes that permits intraoperative identification of the sentinel lymph node, the lymph node nearest the site of the primary melanoma, on the direct drainage pathway. The most likely site of early metastases, the sentinel node can be removed for immediate intraoperative study to identify clinically occult melanoma cells. We successfully identified the sentinel node(s) in 194 of 237 lymphatic basins and detected metastases in 40 specimens (21%) on examination of routine hematoxylin-eosin-stained slides (12%) or exclusively in immunohistochemically stained preparations (9%). Metastases were present in 47 (18%) of 259 sentinel nodes, while nonsentinel nodes were the sole site of metastasis in only two of 3079 nodes from 194 lymphadenectomy specimens that had an identifiable sentinel node, a false-negative rate of less than 1%. Thus, this technique identifies, with a high degree of accuracy, patients with early stage melanoma who have nodal metastases and are likely to benefit from radical lymphadenectomy.