Szintillationssondengesteuerte Sentinel-Lymphadenektomie beim malignen Melanom

Summary. In cutaneous melanoma, biopsy of the first tumor-draining lymph node (Sentinel node, SLN) may replace routine elective lymph-node dissection (ELND). The SLN has been shown to contain the first micrometastasis in early lymphatic tumor dissemination. As micrometastases were identified in 10–30 % of stage I (AJCC/UICC) patients, sentinel lymphonodectomy (SLND) should enable us to select patients clinically in stages I and II, but histopathologically in stage III. This optimization of patient selection is mandatory, as only this subgroup profits from ELND. Since the beginning of 1995 we was scintillation detector (gamma probe)-guided sentinel biopsy in patients with a melanoma > 1.0 mm and clinically negative lymph nodes. After injecting colloidal 99m-Tc-labelled tin(II)-sulfide solution around the tumor (or the biopsy scar), the SLN can be localized exactly. The technique is minimally invasive and easy to handle. If the SLN contains tumor, a standard en bloc lymphonodectomy is performed. Long-term follow-up, however, is needed to delineate the role of this procedure in melanoma treatment.Zusammenfassung. Der Sentinel-Lymphknoten (SLN) entspricht dem ersten Lymphknoten, über den der Primärtumor drainiert wird, d. h. im Frühstadium einer lymphogenen Metastasierung werden in diesem Lymphknoten die ersten Mikrometastasen erwartet. Nachdem bereits im Stadium I (AJCC/UICC) des malignen Melanoms 10–30 % der Patienten Mikrometastasen in den Lymphknoten aufweisen, sollte die Sentinel-Lymphknotendissektion (SLND) eine Differenzierung jener Patienten ermöglichen, die klinisch zwar einem Stadium I und II zuzuordnen sind, pathohistologisch jedoch einem Stadium III entsprechen. Nur sie profitieren von einer elektiven Lymphknotendissektion (ELND). Seit Anfang 1995 führen wir bei Patienten mit einer Melanomdicke > 1 mm nach Breslow und klinisch freien Lymphknoten eine SLND mit Hilfe einer Szintillationsmeßsonde durch. Der betreffende Lymphknoten läßt sich exakt lokalisieren, durch eine kleine Incision gewebeschonend entfernen und seine vollständige Resektion durch eine abschließende Aktivitätsmessung im Operationsgebiet belegen. Bei histologisch nachgewiesenem Tumorbefall schließt sich eine Ausräumung der gesamten Lymphknotenregion an.

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