High negative predictive value of slow lymphatic drainage on metastatic node spread detection in malignant limb and trunk cutaneous melanoma.
High negative predictive value of slow lymphatic drainage on metastatic node spread detection in malignant limb and trunk cutaneous melanoma.
复制标题
缓慢淋巴引流对恶性四肢和躯干皮肤黑色素瘤转移性淋巴结扩散检测的高阴性预测价值。
作者：
Serge Cammilleri;T. Jacob;M. Rojat;S. Hesse;B. Berthet;Roch Giorgi;J. Bonerandi;Olivier Mundler
目的
在恶性黑色素瘤患者的分期中，通过淋巴结造影（LSG）识别的“前哨淋巴结”（SLN）的收获变得越来越重要。本研究的目的是确定LSG的出现时间是否对厚皮恶性黑色素瘤的转移扩散有预测价值。
方法
1999年7月至2003年7月，88例经组织学证实的Breslow厚度> 1 mm的黑色素瘤患者，在前哨淋巴结切除术和前哨淋巴结（SLN）组织学检查之前，前瞻性地接受了32 Mb q Tc 99 m硫胶体淋巴结造影术。
结果
对88例四肢和躯干黑色素瘤患者进行了LSG，共识别出149个前哨淋巴结。病理检查发现淋巴结转移21例（24%）。所有阳性前哨淋巴结的成像时间均小于30 min。当成像时间大于30 min时，前哨淋巴结扩散的阴性预测值（NPV）为100%（27/27）（CI 87-100%）。
结论
LSG在无淋巴结受累临床证据的患者中识别“慢”前哨淋巴结的NPV较强，表明当LSG检测到“慢”前哨淋巴结时，患者可以免于前哨淋巴结活检。需要另一项前瞻性研究来证实前哨淋巴结的淋巴结造影出现时间是前哨淋巴结转移性疾病的重要预测参数，因此可能会减少前哨淋巴结活检的数量。
AIM
Harvesting of the "sentinel lymph node" (SLN) as identified by lymphoscintigraphy (LSG) is becoming increasingly important in the staging of patients with malignant melanoma. The purpose of the current study was to determine whether the appearance time of the LSG had a prognostic value in predicting metastasis dissemination in thick cutaneous malignant melanoma.
METHODS
Between July 1999 and July 2003, 88 consecutive patients with histologically proven melanoma with a Breslow's thickness > 1 mm, without clinical or radiological evidence of lymph node involvement or metastasis, prospectively underwent lymphoscintigraphy with 32 Mbq Tc 99m sulfur colloid prior to sentinel lymphadenectomy with sentinel lymph node (SLN) histological examination.
RESULTS
LSG was performed in 88 patients with limb and trunk melanoma and identified a total of 149 sentinel nodes. Pathological examination revealed lymph node involvement in 21 patients (24%). All positive SLNs were imaged with a scintigraphic appearance time of less than 30 min. With a scintigraphic appearance time greater than 30 min, the negative predictive value (NPV) of spread in the SLN was 100% (27/27)(CI 87-100%).
CONCLUSION
The strong NPV of LSG in identifying "slow" sentinel lymph nodes in patients with no clinical evidence of lymph node involvement suggests that patients could be spared sentinel lymph node biopsy when LSG detects "slow" sentinel lymph nodes. Another prospective study will be required to confirm that the scintigraphic appearance time of sentinel lymph nodes is an important predictive parameter of metastatic disease in sentinel lymph nodes and consequently might reduce the number of sentinel lymph node biopsies.