Sentinel Lymph Node Biopsy and Pathological Examination for Malignant melanoma in the Dermatology Division of National Cancer Center Hospital

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  • 悪性黒色腫のsentinel node biopsyおよび病理組織学的検討
  • アクセイ コクショク シュ ノ sentinel node biopsy オヨビ ビョウリ ソシキガクテキ ケントウ

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Background: The sentinel lymph node (SN) is the first node or nodes to drain a cutaneous melanoma. Sentinel lymph node biopsy (SNB) is performed to determine whether regional metastases are present. The authors report our experience with the techniques of blue dye, lymphoscintigraphy, and a gamma probe of sentinel lymph node biopsy for malignant melanoma. SNB was attempted in 61 patients with clinical node metastasis negative cutaneous melanoma from October 1997 to September 2002 in the Dermatology Division, of National Cancer Center Hospital. Fifty-one patients were injected with blue dye alone. SNs were identified in 42 patients (82.3%). Ten patients underwent lymphoscintigraphy preoperatively. A gamma probe and blue dye helped in localizing the SN. The SNs were identified in 10 patients (100%) by the triple techniques. Collectively, we could identify the SNs in 52 patients (85%). SN metastasis was found to be negative in 39 (75%) of the 52 patients ; the other 13 patients (25%) had one or more positive SNs. Four (10.3%) of the 39 patients developed a recurrence despite having no evidence of metastatic SN. Continuously, we reexamined 57 SNs from the 39 patients reported as negative for malignant melanoma metastasis following routine HE (hematoxylin and eosin) stain. Metastases were apparent in 13 of these 52 patients, and 16 of the 73 SNs. Using the remaining 57 SNs from the 39 patients, we examined immunohistochemically stained deeper sections SNs with antibodies to Mitf (microphthalmia transcription factor), S-100, HMB-45, and Melan-A. These deeper serial sections and immunohistochemical stains detected microscopic metastases in 4 (10.3%) cases and 5 (8.7%) SNs that had been reported as negative for metastasis by routine pathological analysis.

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