不同类型肢端黑色素瘤前哨淋巴结活检结果及评价

Outcomes and evaluation of sentinel lymph node biopsy in different types of acral melanoma

目的肢端恶性黑色素瘤(MM)主要包括手足掌侧和甲下病变,探讨前哨淋巴结活检(SLNB)在不同类型MM中的应用,评价其在不同类型黑色素瘤中的结果及两组的差异。方法回顾性分析本中心自2012—2019年间收治的111例行SLNB的肢端恶性黑色素瘤患者,病理证实手足掌侧MM 84例(A组),甲下MM 27例(B组)。所有患者通过临床和影像学检查无区域淋巴结转移和远处转移,并符合SLNB手术指证。术前采用99mTc-Dextran示踪动态扫描,术中γ射线探测仪精准定位,切取SLN送病理活检。原发灶行扩大切除术,根据术式和缺损进行重建。比较A、B组间SLN阳性率及影响因素。SLN病理阳性患者行区域淋巴结清扫,术后定期随访局部原发灶,区域淋巴结和脑胸腹脏器。结果全组男57例,女54例,平均和中位年龄分别为(60.6±12.9)和60岁(6~89岁)。Ⅰ期31例,Ⅱ期54例,Ⅲ期26例。病史平均55.1个月(2~360个月)。Breslow平均深度A组为3.7 mm,B组为3.2 mm(P=0.157);溃疡A组为53例(63.1%),B组为16例(59.3%)(P=0.721);SLN阳性A组为23例(27.3%),B组为3例(11.1%)(P=0.082);切除SLN数A组平均2.6个,B组平均3.2个(P=0.101)。假阴性率为2.7%。5年总生存率为71.5%,SLN阳性患者5年生存率显著低于SLN阴性患者(P<0.001)。A组Breslow浸润深度是SLN阳性的独立危险因素(P=0.007)。结论临床诊断无区域淋巴结转移患者SLNB能够提供准确的分期,推荐常规开展。手足掌侧MM和甲下MM在生物学行为、SLN阳性率方面相近。Breslow浸润深度是肢端黑色素瘤SLN阳性的独立危险因素。

Objective To investigate the different biological behaviors in Acral malignant melanoma,which mainly includes hands&feet and subungual lesions.And to evaluate the role of sentinel lymph node biopsy(SLNB)in the different types of Melanoma.Methods A retrospective analysis of 111 patients with acral malignant melanoma who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 was presented in our institute.84 cases located in hands&feet(group A),and 27 patients located in hyponychium(group B).We confirmed all patients who enrolled in our research had no regional lymph node and distant metastasis through clinical examination and preoperative imaging of MRI and ultrasonography.The 99mTc-Dextran was used as a dynamic tracer scanning,with intraoperative probe precise localization for sentinel lymph node capture and sent to pathological reviewer.Wide resection and reconstruction in primary lesion were underwent followed by complete lymph node dissection with positive sentinel lymph node patients.We compare the sentinel Lymph Node positive rates between group A and Group B,regular postoperative follow-up items including primary lesions,regional Lymph nodes,brain,chest and abdomen organs.Results There were 57 male and 54 female patients,the mean and median age were 59.7 and 60 respectively(6~89 years)respectively.There were 31 patients in stageⅠ,54 patients in stageⅡ,and 26 patients in stageⅢat final diagnosis.The mean history was 55.1 months(2~360 months).The average Breslow depth was 3.7 mm in group A and 3.2 mm in group B(P=0.157),53 cases of ulceration in group A(63.1%)and 16 cases of group B(59.3%)(P=0.721),SLNB detected 23 cases(27.3%)positive in group A and 3 patients(11.1%)positive in group B(P=0.082),the average SLN number of 2.6 was detected in group A and 3.2 in group B(P=0.101),the total false negative rate was 2.7%.The 5-year overall survival rate was 71.5%,the 5-year survival rate of SLN-positive patients was significantly lower than that of SLN-negative patients(P=0.007).The Breslow infiltration depth was an independent risk factor for SLN positive in group A.Conclusions In clinical negative regional lymph node metastasis patients,SLNB can provide accurate staging and is highly recommended to be carried out routinely in clinical practice.There was no significant difference in biological behavior and SLN positive rate between these different type melanomas.The breslow infiltration depth is an independent risk factor for SLN positive in acral melanoma.