Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck
| Autor: | Vivian S. K. Ka, Richard A. Scolyer, William H. McCarthy, John F. Thompson, Roger F. Uren, Michael J. Quinn, Christopher J. O'Brien, Johannes H. W. de Wilt, Kerwin F. Shannon |
|---|---|
| Přispěvatelé: | Surgery |
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Skin Neoplasms Metastasis Predictive Value of Tests Preoperative Care Biopsy medicine Humans Melanoma Lymph node medicine.diagnostic_test Sentinel Lymph Node Biopsy business.industry Retrospective cohort study Original Articles Sentinel node medicine.disease Surgery Parotid gland Treatment Outcome medicine.anatomical_structure Lymphatic system Head and Neck Neoplasms Lymphatic Metastasis business Lymphoscintigraphy |
| Zdroj: | Annals of Surgery, 239(4), 544-552. Lippincott Williams & Wilkins |
| ISSN: | 0003-4932 |
| Popis: | Sentinel node (SN) biopsy procedures in the head and neck area are often technically demanding. The SNs may be small and are sometimes in sites that are not easily accessible, such as within the parotid gland or deep to the sternomastoid muscle. They may be located close to the primary site, making them difficult to identify following the injection of radioisotope at lymphoscintigraphy or blue dye at the time of surgery. Furthermore, in the head and neck area SNs are frequently found in multiple node fields, in contrast to melanomas located on extremities which usually drain to only 1 field.1,2 Despite these potential difficulties, 75–96% of head and neck SN biopsy procedures are reported to have been successful in studies using blue dye and/or radioisotopes.3–11 Moreover, complications after sentinel node biopsies in the head and neck area are reported to be very infrequent when performed by experienced surgeons.12 If the technique of selective SN biopsy is to provide accurate staging information, it is clearly essential that all SNs are identified and biopsied. However, SNs may be present in clinically unpredicted sites, reached by uncommon lymphatic drainage pathways. In patients with head and neck melanomas, previous studies have demonstrated that 34% to 84% of SNs are located in clinically unexpected (discordant) sites.1,2,13–16 These clinical predictions were based on the location of the primary lesions, and indicate the lymph node fields that surgeons would previously have dissected.17 Nevertheless, elective lymph node dissections of the clinically predicted fields proved to be effective in achieving local disease control in a retrospective study of 108 patients from our institution, with a low regional recurrence rate.18 It is perhaps relevant to note, however, that 3 of the 5 recurrences that occurred following these elective dissections were located outside the dissected field. Whether all sentinel nodes demonstrated by lymphoscintigraphy, including those in discordant sites, are clinically important has therefore been unclear. To examine this issue, we analyzed a large sequential series of patients with head and neck melanomas who underwent lymphoscintigraphy at the Sydney Melanoma Unit (SMU) and correlated the location of their SNs with the location of their primary tumors. We also evaluated the clinical outcome for each patient with respect to metastatic involvement of lymph nodes, and compared this with the clinically predicted pattern of nodal metastasis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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