Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?
| Autor: | Ivan Dunshe Abranches Oliveira Santos, Fernando Augusto de Almeida, Reinaldo Tovo Filho, Renato Santos de Oliveira Filho, Antonio Barbieri, Lydia Massako Ferreira, Milvia M. S. S. Enokihara |
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| Přispěvatelé: | Universidade Federal de São Paulo (UNIFESP) |
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Skin Neoplasms Adolescent medicine.medical_treatment Sentinel lymph node lcsh:Medicine Inguinal Canal Context (language use) behavioral disciplines and activities Intraoperative Period Biopsy medicine Humans Mapeamento linfático Radionuclide Imaging Melanoma Linfocintilografia Aged Aged 80 and over medicine.diagnostic_test Sentinel Lymph Node Biopsy business.industry lcsh:R Dextrans Organotechnetium Compounds General Medicine Middle Aged Linfonodo sentinela detecção gama Sentinel node medicine.disease Primary tumor Inguinal canal Surgery medicine.anatomical_structure Evaluation Studies as Topic Female Lymphadenectomy Radiology Radiopharmaceuticals Lymphatic mapping business Gamma detection Lymphoscintigraphy Gamma probe |
| Zdroj: | Sao Paulo Medical Journal, Volume: 118, Issue: 6, Pages: 165-168, Published: 09 NOV 2000 Sao Paulo Medical Journal v.118 n.6 2000 São Paulo medical journal Associação Paulista de Medicina instacron:APM Repositório Institucional da UNIFESP Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP São Paulo Medical Journal, Vol 118, Iss 6, Pp 165-168 (2000) |
| ISSN: | 1516-3180 |
| Popis: | CONTEXTO: A biópsia de linfonodo sentinela (LS) mudou a abordagem cirúrgica do melanoma maligno. A literatura tem enfatizado a importância da detecção gama intra-operatória (DG) do LS. OBJETIVO: Nosso objetivo é avaliar a eficácia do corante azul patente (AP) e da DG na biópsia de LS em diferentes bases linfáticas. TIPO DE ESTUDO: Pacientes portadores de melanoma maligno cutâneo foram submetidos à biópsia do LS, usando AP e DG como parte de um projeto de pesquisa. LOCAL: Hospital São Paulo, grupo multidisciplinar (cirurgião oncológico, médico nuclear e patologista). PACIENTES: Foram estudados 64 pacientes portadores de melanoma maligno localizado, com idade mediana de 46,5 anos. O sítio primário estava localizado no pescoço, tronco e nos membros. INTERVENÇÕES: Linfocintilografia pré-operatória, mapeamento linfático com AP e DG foram realizados em todos os pacientes. O LS foi examinado por histopatologia convencional e imunohistoquímica. Quando o LS não foi encontrado ou continha micrometástases, linfadenectomia completa da base linfática foi realizada. VARIÁVEIS ESTUDADAS: O LS foi considerado como identificado pelo AP se corado em azul e pela DG quando demonstrou pelo menos 5 vezes mais atividade do que o tecido gorduroso vizinho. RESULTADOS: Foram exploradas 70 bases linfáticas. A linfocintilografia mostrou drenagem ambígua em 7 pacientes. DG identificou o LS em 68 bases linfáticas (97%) e o AP o fez em 53 bases (76%). Os dois métodos identificaram separadamente 100% dos LS inguinais. Nas demais bases, as técnicas foram complementares. O LS estava invadido por células tumorais em 10 bases. Três pacientes com LS negativo apresentaram recorrência (seguimento mediano de 11 meses). CONCLUSÃO: Embora o emprego de AP e GP na pesquisa de LS sejam complementares, o AP demonstrou ser um método suficiente para a localização do LS inguinal. CONTEXT: Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. OBJECTIVE: Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. DESIGN: Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. SETTING: Patients were seen at Hospital São Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology). PATIENTS: 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. INTERVENTIONS: Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD was performed on all patients. The SN was examined by conventional and immunohistochemical staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. MAIN MEASUREMENTS: The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. RESULTS: Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage in 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up = 11 months). CONCLUSION: Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Discipline of Plastic Surgery/Tumor branch Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Dermatology Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Nuclear Medicine UNIFESP, EPM, Discipline of Plastic Surgery/Tumor branch UNIFESP, EPM, Department of Dermatology UNIFESP, EPM, Department of Nuclear Medicine SciELO |
| Databáze: | OpenAIRE |
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