背景:在侵袭性皮肤黑色素瘤的前哨淋巴结活检(SLNB)之前,通常使用平面淋巴闪烁显像(PL)。最近,单光子发射计算机断层扫描(SPECT)/计算机断层扫描(CT)已被利用,除了PL,详细的解剖信息和检测的前哨淋巴结(SLN)在原发淋巴结盆地的躯干和头颈部黑色素瘤。在由于COVID-19而改变方案之后,我们的机构开始常规获得所有黑色素瘤SLN定位的PL和SPECT-CT成像。我们假设SPECT-CT与四肢黑素瘤的“非传统”结节盆(NTNB)中SLNB的较高实例相关。
方法:将接受SLNB的四肢黑色素瘤(2017-2022)患者分为SPECT-CT和PL与单独PL。结果是删除了总SLN,+或-SLN状态,总NTNB采样,术后并发症发生率。使用泊松回归和逻辑回归模型来评估SPECT-CT与患者预后的关联。
结果:在380例四肢黑色素瘤患者中,42.11%行SPECT-CT检查。两组之间在诊断年龄或性别方面没有差异。从2020年到2022年,所有患者均接受SPECT-CT检查。SPECT-CT与NTNB的SLNB几率增加相关,(比值比=2.39[95%置信区间:1.25-4.67])。采样的SLN的几率没有差异,SLN阳性率,或术后并发症发生率与SPECT-CT。
结论:常规SPECT-CT与NTNB中SLNB的发生率较高相关,但未增加SLN的清除数量或SLN阳性率。常规SPECT-CT在四肢皮肤黑色素瘤中的附加值尚待确定。
BACKGROUND: Planar lymphoscintigraphy (PL) is commonly used in mapping before sentinel lymph node biopsy (SLNB) for invasive cutaneous melanoma. Recently, single-photon emission computed tomography (SPECT)/ computed tomography (CT) has been utilized, in addition to PL, for detailed anatomic information and detection of sentinel lymph nodes (SLNs) outside of the primary nodal basin in truncal and head and neck melanoma. Following a protocol change due to COVID-19, our institution began routinely obtaining both PL and SPECT-CT imaging for all melanoma SLN mapping. We hypothesized that SPECT-CT is associated with higher instances of SLNBs from \"nontraditional\" nodal basins (NTNB) for extremity melanomas.
METHODS: Patients with extremity melanoma (2017-2022) who underwent SLNB were grouped into SPECT-CT with PL versus PL alone. Outcomes were total SLNs removed, + or-SLN status, total NTNB sampled, and postoperative complication rate. Poisson regression and logistic regression models were used to assess association of SPECT-CT with patient outcomes.
RESULTS: Of 380 patients with extremity melanoma, 42.11% had SPECT-CT. There were no differences between the groups with regards to age at diagnosis or sex. From 2020 to 2022, all patients underwent SPECT-CT. SPECT-CT was associated with increased odds of SLNB from an NTNB, (odds ratio = 2.39 [95% confidence interval: 1.25-4.67]). There was no difference in odds of number of SLNs sampled, SLN positivity rate, or postoperative complication rate with SPECT-CT.
CONCLUSIONS: Routine SPECT-CT was associated with higher incidence of SLNB in NTNB but did not increase number of SLNs removed or SLN positivity rate. The added value of routine SPECT-CT in cutaneous melanoma of the extremities remains to be defined.