Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas
Identifieur interne : 000C07 ( Pmc/Curation ); précédent : 000C06; suivant : 000C08Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas
Auteurs : Lutz Kretschmer [Allemagne] ; Carsten-Oliver Sahlmann [Allemagne] ; Pavel Bardzik [Allemagne] ; Christina Mitteldorf [Allemagne] ; Hans-Joachim Helms [Allemagne] ; Johannes Meller [Allemagne] ; Michael Peter Schön [Allemagne] ; Hans Peter Bertsch [Allemagne]Source :
- Annals of Surgical Oncology [ 1068-9265 ] ; 2013.
Abstract
The value of a preoperative lymphoscintigraphy in melanoma patients with clinically evident regional lymph node metastases has not been studied. Therapeutic lymph node dissection (TLND) is regarded as the clinical standard, but the appropriate extent of TLND is controversial in all lymphatic basins.
Of the 115 consecutive patients with surgery on palpable lymph node metastases, 34 received a pre-operative lymphoscintigraphy. Lymphatic drainage to a second nodal basin outside the clinically involved basin was found in 15 cases. In 13 patients, the ectopic tumor-draining lymph nodes were excised as in a sentinel node biopsy. The lymph nodes from the TLND specimens were postoperatively separated and classified as either radioactive or non-radioactive.
A total of 493 lymph nodes were examined pathologically. The largest macrometastasis maintained the ability to take up radiotracer in 77% of cases. Radioactively labeled lymph nodes carried a higher risk of being involved with metastasis. The proportions of tumor involvement for radioactive and non-radioactive lymph nodes were 44.5 and 16.9%, respectively (
In patients undergoing TLND for palpable metastases, tumor-draining lymph nodes in a second, ectopic nodal basin should be excised, because they could be affected by occult metastasis. With respect to radioactive lymph nodes situated within the nodal basin of the macrometastasis but beyond the borders of a less-radical lymphadenectomy, further studies are needed.
Url:
DOI: 10.1245/s10434-012-2841-1
PubMed: 23314605
PubMed Central: 3618405
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Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Bardzik, Pavel" sort="Bardzik, Pavel" uniqKey="Bardzik P" first="Pavel" last="Bardzik">Pavel Bardzik</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Mitteldorf, Christina" sort="Mitteldorf, Christina" uniqKey="Mitteldorf C" first="Christina" last="Mitteldorf">Christina Mitteldorf</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany</nlm:aff><country 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xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Schon, Michael Peter" sort="Schon, Michael Peter" uniqKey="Schon M" first="Michael Peter" last="Schön">Michael Peter Schön</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Bertsch, Hans Peter" sort="Bertsch, Hans Peter" uniqKey="Bertsch H" first="Hans Peter" last="Bertsch">Hans Peter Bertsch</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23314605</idno><idno type="pmc">3618405</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618405</idno><idno type="RBID">PMC:3618405</idno><idno type="doi">10.1245/s10434-012-2841-1</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000C08</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C08</idno><idno type="wicri:Area/Pmc/Curation">000C07</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C07</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas</title><author><name sortKey="Kretschmer, Lutz" sort="Kretschmer, Lutz" uniqKey="Kretschmer L" first="Lutz" last="Kretschmer">Lutz Kretschmer</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Sahlmann, Carsten Oliver" sort="Sahlmann, Carsten Oliver" uniqKey="Sahlmann C" first="Carsten-Oliver" last="Sahlmann">Carsten-Oliver Sahlmann</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Bardzik, Pavel" sort="Bardzik, Pavel" uniqKey="Bardzik P" first="Pavel" last="Bardzik">Pavel Bardzik</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Mitteldorf, Christina" sort="Mitteldorf, Christina" uniqKey="Mitteldorf C" first="Christina" last="Mitteldorf">Christina Mitteldorf</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim</wicri:regionArea></affiliation></author><author><name sortKey="Helms, Hans Joachim" sort="Helms, Hans Joachim" uniqKey="Helms H" first="Hans-Joachim" last="Helms">Hans-Joachim Helms</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Medical Statistics, Georg August University of Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Statistics, Georg August University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Meller, Johannes" sort="Meller, Johannes" uniqKey="Meller J" first="Johannes" last="Meller">Johannes Meller</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Schon, Michael Peter" sort="Schon, Michael Peter" uniqKey="Schon M" first="Michael Peter" last="Schön">Michael Peter Schön</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen</wicri:regionArea></affiliation></author><author><name sortKey="Bertsch, Hans Peter" sort="Bertsch, Hans Peter" uniqKey="Bertsch H" first="Hans Peter" last="Bertsch">Hans Peter Bertsch</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen</wicri:regionArea></affiliation></author></analytic><series><title level="j">Annals of Surgical Oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The value of a preoperative lymphoscintigraphy in melanoma patients with clinically evident regional lymph node metastases has not been studied. Therapeutic lymph node dissection (TLND) is regarded as the clinical standard, but the appropriate extent of TLND is controversial in all lymphatic basins.</p></sec><sec><title>Patients and Methods</title><p>Of the 115 consecutive patients with surgery on palpable lymph node metastases, 34 received a pre-operative lymphoscintigraphy. Lymphatic drainage to a second nodal basin outside the clinically involved basin was found in 15 cases. In 13 patients, the ectopic tumor-draining lymph nodes were excised as in a sentinel node biopsy. The lymph nodes from the TLND specimens were postoperatively separated and classified as either radioactive or non-radioactive.</p></sec><sec><title>Results</title><p>A total of 493 lymph nodes were examined pathologically. The largest macrometastasis maintained the ability to take up radiotracer in 77% of cases. Radioactively labeled lymph nodes carried a higher risk of being involved with metastasis. The proportions of tumor involvement for radioactive and non-radioactive lymph nodes were 44.5 and 16.9%, respectively (<italic>P</italic>=0.00002). Of the 13 ectopic nodal basins surgically explored, six harbored clinically occult metastases.</p></sec><sec><title>Conclusion</title><p>In patients undergoing TLND for palpable metastases, tumor-draining lymph nodes in a second, ectopic nodal basin should be excised, because they could be affected by occult metastasis. With respect to radioactive lymph nodes situated within the nodal basin of the macrometastasis but beyond the borders of a less-radical lymphadenectomy, further studies are needed.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Meier, F" uniqKey="Meier F">F Meier</name></author><author><name sortKey="Will, S" uniqKey="Will S">S Will</name></author><author><name sortKey="Ellwanger, U" uniqKey="Ellwanger U">U Ellwanger</name></author><author><name sortKey="Schlagenhauff, B" uniqKey="Schlagenhauff B">B Schlagenhauff</name></author><author><name sortKey="Schittek, B" uniqKey="Schittek B">B Schittek</name></author><author><name sortKey="Rassner, G" uniqKey="Rassner G">G Rassner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mchugh, Jb" uniqKey="Mchugh J">JB McHugh</name></author><author><name sortKey="Su, L" uniqKey="Su L">L Su</name></author><author><name sortKey="Griffith, Ka" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Surg Oncol</journal-id><journal-id journal-id-type="iso-abbrev">Ann. Surg. Oncol</journal-id><journal-title-group><journal-title>Annals of Surgical Oncology</journal-title></journal-title-group><issn pub-type="ppub">1068-9265</issn><issn pub-type="epub">1534-4681</issn><publisher><publisher-name>Springer-Verlag</publisher-name><publisher-loc>New York</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23314605</article-id><article-id pub-id-type="pmc">3618405</article-id><article-id pub-id-type="publisher-id">2841</article-id><article-id pub-id-type="doi">10.1245/s10434-012-2841-1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Melanomas</subject></subj-group></article-categories><title-group><article-title>Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Kretschmer</surname><given-names>Lutz</given-names></name><degrees>MD</degrees><address><email>lkre@med.uni-goettingen.de</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Sahlmann</surname><given-names>Carsten-Oliver</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Bardzik</surname><given-names>Pavel</given-names></name><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Mitteldorf</surname><given-names>Christina</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Helms</surname><given-names>Hans-Joachim</given-names></name><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Meller</surname><given-names>Johannes</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Schön</surname><given-names>Michael Peter</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Bertsch</surname><given-names>Hans Peter</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany</aff><aff id="Aff2"><label></label>Department of Nuclear Medicine, Georg-August-University of Göttingen, Göttingen, Germany</aff><aff id="Aff3"><label></label>Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany</aff><aff id="Aff4"><label></label>Department of Medical Statistics, Georg August University of Göttingen, Göttingen, Germany</aff></contrib-group><pub-date pub-type="epub"><day>12</day><month>1</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>12</day><month>1</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2013</year></pub-date><volume>20</volume><issue>5</issue><fpage>1714</fpage><lpage>1721</lpage><history><date date-type="received"><day>8</day><month>6</month><year>2012</year></date><date date-type="accepted"><day>4</day><month>12</month><year>2012</year></date></history><permissions><copyright-statement>© The Author(s) 2013</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>The value of a preoperative lymphoscintigraphy in melanoma patients with clinically evident regional lymph node metastases has not been studied. Therapeutic lymph node dissection (TLND) is regarded as the clinical standard, but the appropriate extent of TLND is controversial in all lymphatic basins.</p></sec><sec><title>Patients and Methods</title><p>Of the 115 consecutive patients with surgery on palpable lymph node metastases, 34 received a pre-operative lymphoscintigraphy. Lymphatic drainage to a second nodal basin outside the clinically involved basin was found in 15 cases. In 13 patients, the ectopic tumor-draining lymph nodes were excised as in a sentinel node biopsy. The lymph nodes from the TLND specimens were postoperatively separated and classified as either radioactive or non-radioactive.</p></sec><sec><title>Results</title><p>A total of 493 lymph nodes were examined pathologically. The largest macrometastasis maintained the ability to take up radiotracer in 77% of cases. Radioactively labeled lymph nodes carried a higher risk of being involved with metastasis. The proportions of tumor involvement for radioactive and non-radioactive lymph nodes were 44.5 and 16.9%, respectively (<italic>P</italic>=0.00002). Of the 13 ectopic nodal basins surgically explored, six harbored clinically occult metastases.</p></sec><sec><title>Conclusion</title><p>In patients undergoing TLND for palpable metastases, tumor-draining lymph nodes in a second, ectopic nodal basin should be excised, because they could be affected by occult metastasis. With respect to radioactive lymph nodes situated within the nodal basin of the macrometastasis but beyond the borders of a less-radical lymphadenectomy, further studies are needed.</p></sec></abstract><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© Society of Surgical Oncology 2013</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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