PDF(Pubmed)
Abstract：
According to the American Joint Commission on Cancer (AJCC) 8th edition guidelines, SLN biopsy is recommended for primary melanomas with a Breslow thickness of at least 1 mm. Additionally, the National Comprehensive Cancer Network (NCCN) recommends that a SLN biopsy may be considered for melanoma patients with T1b lesions, which are 0.8-1 mm thick or less than 0.8 mm thick with ulceration. It can also be considered for T1a lesions that are less than 0.8 mm thick but have other adverse features, such as a high mitotic rate, lymphovascular invasion, or a positive deep margin. To reduce the false negative rate of melanoma SLN biopsy, we have introduced the intraoperative use of Sentinella, a gamma camera, to enhance the identification rate of SLNs beyond that of the traditional gamma hand-held probe. At the Center for Melanoma Research and Treatment at the California Pacific Medical Center, a multidisciplinary approach has been established to treat melanoma patients when the diagnosis of primary melanoma is made with a referral to our melanoma center. This comprehensive approach at the melanoma tumor board, including the efforts of pathologists, radiologists, dermatologists, surgical, medical and radiation oncologists, results in a consensus to deliver personalized and high-quality care for our melanoma patients. This multidisciplinary program for the management of melanoma can be duplicated for other types of cancer. This article consists of current knowledge to document the published methods of identification of sentinel lymph nodes. In addition, we have included new data as developed in our melanoma center as newly published materials in this article to demonstrate the utility of these methods in melanoma sentinel lymph node surgery. Informed consent has been waived by our IRB regarding the acquisition of clinical data as presented in this study.
摘要：
根据美国癌症联合委员会（AJCC）第8版指南，对于Breslow厚度至少为1mm的原发性黑色素瘤，建议进行SLN活检。此外,国家综合癌症网络（NCCN）建议对T1b病变的黑色素瘤患者进行SLN活检，厚度为0.8-1毫米或厚度小于0.8毫米的溃疡。也可以考虑厚度小于0.8mm但具有其他不利特征的T1a病变。如高有丝分裂率，淋巴管浸润,或正的深度利润。降低黑色素瘤SLN活检假阴性率,我们介绍了术中使用Sentinella,伽马相机,以提高SLN的识别率，超越传统的gamma手持探头。在加州太平洋医学中心黑色素瘤研究和治疗中心，当原发性黑色素瘤的诊断是通过转诊到我们的黑色素瘤中心时,已经建立了多学科方法来治疗黑色素瘤患者.黑色素瘤肿瘤委员会的这种综合方法，包括病理学家的努力，放射科医生,皮肤科医生,外科,医学和放射肿瘤学家，结果达成共识，为我们的黑色素瘤患者提供个性化和高质量的护理。这种用于治疗黑色素瘤的多学科计划可以重复用于其他类型的癌症。本文包含当前的知识，以记录已发布的前哨淋巴结识别方法。此外,我们纳入了我们黑色素瘤中心开发的新数据作为本文新发表的材料，以证明这些方法在黑色素瘤前哨淋巴结手术中的实用性。我们的IRB放弃了关于本研究中提供的临床数据获取的知情同意书。
