99Tcm-IT-Rituximab示踪的前哨淋巴结活检在四肢皮肤恶性黑色素瘤中的应用

摘要

Objective:To evaluate the accuracy and feasibility of sentinel lymph node biopsy (SLNB) marked by 99Tcm-IT-Ritux-imab and to discuss the clinical value of the method in diagnosis and treatment of cutaneous melanoma. Methods:A total of 67 patients with cutaneous malignant melanoma received 99Tcm-IT-Rituximab-tagged SLNB from March 2008 to March 2012. Lymphoscintigra-phy was conducted 30 min to 1 h after intra-dermal injection of 99Tcm-IT-Rituximab. Subsequently, the surgery of SLNB was carried out using gamma probe. The detection and positive rates of SLNB were counted. The relationship between the status and the clinical features of the sentinel lymph node (SLN) was analyzed, such as the T stage, ulceration, age, gender, and location. The influence of SLN status on overall survival (OS) and disease-free survival (DFS) was evaluated. Results:SLNs were detected in all the 67 patients by SPECT and gamma detector, with detection rate of 100%. Fifteen patients had SLN metastasis, and the positive rate was 22.4%. Chi-square indicates that SLN metastasis is associated with age, T stage, and ulceration (P<0.05). A total of 63 patients were followed up for 24-69 months, and the median follow up time was 43 months. Kaplan-Meier survival analysis shows that both OS and DFS in the SLN-negative group are better than those in the SLN-positive group (OS:93.9%vs. 57.1%, P<0.01;DFS:79.6%versus 28.6%, P<0.01). Cox-regression multiple factors analysis suggests that both SLN status and T stage are independent factors that affect the DFS of malignant melanoma. Conclusion:SLNB assisted by 99Tcm-IT-Rituximab can well reflect the state of lymph node metastasis and is es-sential for accurate staging, prognosis judging, and treatment guiding. Its operation procedure is simple with high accuracy, and the im-aging status is stable. Therefore, it is convenient and feasible as a means of SLNB.%目的：研究99Tcm-IT-Rituximab示踪的前哨淋巴结活检（sentinel lymph node biopsy，SLNB）的准确性及可行性；探讨其在四肢皮肤恶性黑色素瘤（malignant melanoma，MM）诊治中的应用价值。方法：2008年3月至2012年3月期间，北京肿瘤医院骨与软组织肿瘤科收治的67例四肢皮肤MM患者接受99Tcm-IT-Rituximab示踪的SLNB。统计SLNB的检出率和阳性率，分析SLB状态与T分期、溃疡、年龄、性别、部位等临床特征的关系，分析其对总生存时间（overall survival ，OS）和无病生存时间（disease free survival，DFS）的影响。结果：67例患者均通过γ探测仪检测到SLN，检出率为100%；SLN阳性15例，阳性率为22.4%。χ2检验提示SLN转移与患者年龄、原发灶T分期及是否溃疡有关（P<0.05）。63例患者获得随访，随访时间24～69个月，中位随访时间43个月；Kaplan-Meier生存分析显示，SLN阴性组的3年OS和DFS均优于SLN阳性组（OS：93.9%vs.57.1%， P<0.01；DFS：79.6%vs.28.6%，P<0.01）；Cox多因素回归分析提示SLN状态和T分期是影响黑色素瘤DFS的独立因素。结论：99Tcm-IT-Rituximab标记的SLNB能很好地反映恶性黑色素瘤的淋巴结转移状态，对判断预后、准确分期和指导治疗有重要的意义；其操作简单，准确性良好，是一种方便可行的SLNB手段。