Současný stav biopsie sentinelové uzliny u pacientů s melanomem

Sentinelová uzlina je definovaná jako spádová lymfatická uzlina na přímé dráze lymfatické drenáže od primárního tumoru. Biopsie sentinelové uzliny je invazivní a potenciálně komplexní diagnostický test, který vyžaduje značnou zručnost a zkušenost lékařů nukleární medicíny, chirurgů a patologů, kteří se touto metodou zabývají. Tento výkon přináší důležité informace o stádiu onemocnění. Status regionálních lymfatických uzlin je nejdůležitější prognostický factor u pacientů s klinicky lokalizovaným melanomem. Nedávno publikovaná závěrečná zpráva z první Multicentrické studii na selektivní lymfadektomii (MSLT-1) ukazuje, že biopsie sentinelové uzliny s následnou disekcí regionálních uzlin zlepšuje přežívání u pacientů s metastázami do uzlin z melanomu o střední tloušce podle Breslowa (1,2−3,5 mm). Počet falešně negativních výsledků je sice značný, ale dá se omezit zkušenostmi, precizní technikou a úzkou spoluprácí mezi zúčastněnými specialisty. Chirurgické odstranění sentinelových uzlin je spojeno s minimální morbiditou.

Biopsie sentinelové uzliny je nyní součástí standardního postupu u pacientů s melanomem střední tloušťky, a dá se o ní uvažovat u tenčích či tlustších melanomů. Nové detekční látky (tzv. tracery) lymfatických uzlin a inovativní zobrazovací techniky by měly dále zlepšit senzitivitu metody. Nyní, když jsou dostupné výsledky MSLT-1, je další otázkou, zda by pacienti s pozitivní sentinelovou uzlinou měli podstoupit další chirurgický výkon. Na tuto problematiku je zaměřena studie Minitub prováděna EORTC a studie MSLT-2. Do doby, než budou k dispozici výsledky těchto studií, je disekce regionálních uzlin doporučena u pacientů s metastázami sentinelových uzlin.

Klíčová slova:
melanom − review − biopsie sentinelové uzliny – staging − přežívání

Autoři: O. E. Nieweg ^1,2
Působiště autorů: Melanoma Institute Australia, North Sydney ¹; The Mater Hospital, North Sydney ²
Vyšlo v časopise: Rozhl. Chir., 2014, roč. 93, č. 10, s. 485-490.
Kategorie: Souhrnné sdělení

Souhrn

Klíčová slova:
melanom − review − biopsie sentinelové uzliny – staging − přežívání

Zdroje

1. Hollestein LM, van den Akker SA, Nijsten T, et al. Trends of cutaneous melanoma in The Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989. Ann Oncol 2012;23:524−530.

2. Veronesi U, Adamus J, Bandiera DC, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 1982;49:2420−2430.

3. Sim FH, Taylor WF, Pritchard DJ, et al. Lymphadenectomy in the management of stage I malignant melanoma: A prospective randomized study. Mayo Clinics Proc 1986;61:697−705.

4. Balch CM, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996; 224:255−266.

5. Cascinelli N, Morabito A, Santinami M, et al. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomized trial. WHO melanoma programme. Lancet 1998;351:793−796.

6. Balch CM, Soong S-J, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:3622−3634.

7. Morton DL, Hoon DS, Cochran AJ, et al. Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg 2003;238:538−549.

8. Kretschmer L, Hilgers R, Mohrle M, et al. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. Eur J Cancer 2004;40:212−218.

9. Starz H, Siedlecki K, Balda BR. Sentinel lymphonodectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol 2004;11(3 Suppl):162S−8S.

10. Nowecki ZI, Rutkowski P, Michej W. The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm (pT2-pT3). Ann Surg Oncol 2008;15:2223−2234.

11. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392−399.

12. Nieweg OE, Jansen L, Kroon BBR. Technique of lymphatic mapping and sentinel node biopsy for melanoma. Eur J Surg Oncol 1998;24:520−524.

13. Vuylsteke RJ, van Leeuwen PA, Muller MG, et al. Clinical outcome of stage I/II melanoma patients after selective sentinel lymph node dissection: long-term follow-up results. J Clin Oncol 2003;21:1057−1065.

14. Estourgie SH, Nieweg OE, Valdés Olmos RA, et al. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 2003;10:681−688.

15. Morton DL, Bostick PJ. Will the true sentinel node please stand? Ann Surg Oncol 1999;6:12−14.

16. Balch CM, Ross MI. Sentinel lymphadenectomy for melanoma - is it a substitute for elective lymphadenectomy? Ann Surg Oncol 1999;6:416−417.

17. Thompson JF, Uren RF. What is a ‘sentinel’ lymph node? Eur J Surg Oncol 2000;26:103−104.

18. Nieweg OE, Tanis PJ, Kroon BBR. The definition of a sentinel node. Ann Surg Oncol 2001;9:538−541.

19. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997;349:1864−1867.

20. De Cicco C, Sideri M, Bartolomei M, et al. Sentinel node detection by lymphoscintigraphy and gamma detecting probe in patients with vulvar cancer. J Nucl Med 1997;38:33P.

21. Gershenwald JE, Tseng CH, Thompson W, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery 1998;124:203−210.

22. Boxen I, McCready D, Ballinger JR. Sentinel node detection and definition may depend on the imaging agent and timing. Clin Nucl Med 1999;24:390−394.

23. Gershenwald JE, Thompson W, Mansfield PF, et al: Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976−983.

24. Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg 2000;87:484−489.

25. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol, 2001;19:3635−3648.

26. Garreau JR, Farries MB, Ye X, et al. Mood state and melanoma outcome in the Multicenter Selective Lymphadenectomy Trial J Clin Oncol 2009;27:15S, abstract 9603.

27. Gershenwald JE, Berman RS, Porter G, et al. Regional nodal basin control is not compromised by previous sentinel lymph node biopsy in patients with melanoma. Ann Surg Oncol 2000;7:226−231.

28. Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg 2002;184:520−524.

29. Lee RJ, Gibbs JF, Proulx GM, et al. Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 2000;46:467−474.

30. Gershenwald JE, Ross MI. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med 2011;364:1738−1745.

31. Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol 2010;17:3324−3329.

32. Estourgie SH, Nieweg OE, Kroon BBR. High incidence of in-transit metastases after sentinel node biopsy in patients with melanoma. Br J Surg 2004;91:1370−1371.

33. Veenstra HJ, van der Ploeg IMC, Wouters MWJM, et al. Reevaluation of the locoregional recurrence rate in melanoma patients with a positive sentinel node compared to patients with palpable nodal involvement. Ann Surg Oncol 2010;17:521−426.

34. Veenstra H.J, Wouters MJWM, Kroon BBR, et al. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol 2011;104:454-457.

35. Nieweg OE, Tanis PJ, de Vries JDH, et al. Sensitivity of sentinel node biopsy in melanoma. J Surg Oncol 2001;78:223−224.

36. Nieweg OE. False-negative sentinel node biopsy. Ann Surg Oncol 2009;16:2089−2091.

37. van der Ploeg IMC, Nieweg OE, van Rijk MC, et al. Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: A systematic review and meta-analysis of the literature. Eur J Surg Oncol 2008; 34:1277−1284.

38. Rosenberg SA. Why perform sentinel-lymph-node biopsy in patients with melanoma? Nat Clin Pract Oncol 2008;5:1.

39. Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol 2008;5:18−23.

40. Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel-node biopsy in primary melanoma. Nat Clin Pract Oncol 2008;5:510−511.

41. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 2014; 370:599−609.

42. Uren RF. SPECT/CT Lymphoscintigraphy to locate the sentinel lymph node in patients with melanoma. Ann Surg Oncol 2009;16:1459−1460.

43. Vermeeren L, Valdés Olmos RA, Klop, WM, et al. SPECT/CT for sentinel lymph node mapping in head and neck melanoma. Head Neck 2011;33:1−6.

44. Veenstra HJ, Vermeeren L, Valdés Olmos RA, et al. The additional value of lymphatic mapping with routine SPECT/CT in unselected patients with clinically localized melanoma. Ann Surg Oncol 2012;19:1018−1023.

45. Buckle T, van Leeuwen AC, Chin PT, et al. A self-assembled multimodal complex for combined pre- and intraoperative imaging of the sentinel lymph node. Nanotechnol 2010;21: 355101.

46. Brouwer OR, Klop WM, Buckle T, et al. Feasibility of sentinel node biopsy in head and neck melanoma using a hybrid radioactive and fluorescent tracer. Ann Surg Oncol 2012;19:1988−1994.

47. Brouwer OR, Buckle T, Vermeeren L, et al. Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mTc-nanocolloid with 99mTc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med 2012;53:1034−1040.

48. Wendler T, Herrmann K, Schnelzer A, et al. First demonstration of 3-D lymphatic mapping in breast cancer using freehand SPECT. Eur J Nucl Med Mol Imaging 2010; 37:1452−1461.

49. Mihaljevic AL, Rieger A, Belloni B, et al. Transferring innovative freehand SPECT to the operating room: first experiences with sentinel lymph node biopsy in malignant melanoma. Eur J Surg Oncol 2014;40:42−48.

50. Wong SL, Morton DL, Thompson JF, et al. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 2006;13:809−816.

51. Scheri RP, Essner R, Turner RR, et al. Do isolated tumor cells in the sentinel node in melanoma affect long-term prognosis? Ann Surg Oncol 2007;14, Suppl: 11.

52. Veenstra HJ, Brouwer OR, van der Ploeg IMC, et al. Five-year follow-up of 16 melanoma patients with a Starz I-involved sentinel node in whom completion lymph node dissection was omitted. Melanoma Res 2012;22:436−439.

53. Scolyer RA, Murali R, Satzger I, et al. The detection and significance of melanoma micrometastases in sentinel nodes. Surg Oncol 2008;17:165−174.

54. Eggermont AMM, Chiarion-Sileni V, Grob JJ, et al. Ipilimumab versus placebo after complete resection of stage III melanoma: Initial efficacy and safety results from the EORTC 18071 phase III trial. J Clin Oncol 2014,32: LBA9008.