Validnost ultrazvučno vođene aspiracije tankom iglom u dijagnostici mikrometastaza u limfnim čvorovima stražarima kod obolelih od melanoma kože

  • Goran Šijan Clinic for Plastic Surgery and Burns,Military Medical Academy, Belgrade, Serbia;Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Jefta V Kozarski Clinic for Plastic Surgery and Burns,Military Medical Academy, Belgrade, Serbia;Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Nenad Stepić Clinic for Plastic Surgery and Burns,Military Medical Academy, Belgrade, Serbia;Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Saša Milojević Department of Cytology, Military Medical Academy, Belgrade, Serbia
  • Dara Stefanović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute for Radiology,Military Medical Academy, Belgrade, Serbia
  • Željka Tatomirović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Department of Cytology,Military Medical Academy, Belgrade, Serbia
  • Ljiljana Jauković Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute for Nuclear Medicine, Military Medical Academy, Belgrade, Serbia
  • Svetlana Vesanović Private Practice for Plastic and Reconstructive Surgery “Vesanović dr Svetlana”, Belgrade, Serbia
  • Milica Rajović Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150227042S
Ključne reči: endoscopic ultrasound-guided fine needle aspiration||, ||endoskopska, ultrazvukom-vođena, aspiracija tankom iglom, neoplasm, micrometastasis||, ||neoplazma, mikrometastaza, sentinel lymph node biopsy||, ||limfni čvorovi, stražarski, biopsija, skin||, ||koža, melanoma||, ||melanom, diagnosis||, ||dijagnoza, sensitivity and specificity||, ||senzitivnost i specifičnost,

Sažetak


Uvod/Cilj. Kožni melanom je jedan od najagresivnijih solidnih malignih tumora, koji se širi lokalno, regionalno i udaljeno metastazira. Prisustvo metastaza u limfnim čvorovima u vezi je sa debljinom tumora prema Breslow-u. Prema različitim istraživanjima, kod melanoma debljih od 4 mm prema Breslow-u, mikrometastaze u limfnim čvorovima mogu se naći kod 60–70% slučajeva. Biopsija limfnog čvora stražara je dijagnostička procedura za otkrivanje mikrometastaza u limfnim čvorovima, što je neophodno za određivanje stadijuma bolesti. U poslednjim istraživanjima, ultrazvučno vođena aspiracija tankom iglom (UZ ATI) sa citološkim nalazom limfnog čvora stražara korišćena je kao manje invazivna procedura, ali nije prihvaćena kao standardna peocedura. Cilj ovog rada bio je da se definiše senzitivnost, specifičnost i tačnost metode ultrazvučnog vođenja aspiracije tankom iglom u odnosu na standardnu biopsiju limfnog čvora stražara. Metode. Nakon dobijanja dozvole Etičkog komiteta u periodu od 2012. do 2014. godine, 60 bolesnika sa kožnim melanomom grupisano je u tri grupe: grupa I sa tankim melanomom, grupa II sa intermedijarnom debljinom melanoma i grupa III sa debelim melanomom. Prisustvo mikrometastaza u regionalnim limfnim čvorovima stražarima analizirano je UZ ATI sa citološkom analizom. Dobijeni rezultati su poređeni sa rezultatima biopsija limfnog čvora stražara. (BLCS) Zlatni standard za izračunavanje specifičnosti, senzitivnosti i tačnosti metoda UZ ATI limfnog čvora stražara je bio patohistološki nalaz limfnih čvorova dobijenih biopsijom limfnog čvora stražara. Rezultati. Dobijeni rezultati UZ ATI bili su 0% u grupi I, 5% u gupi II i 30% u grupi III. Dobijeni rezultati BLČS bili su: 10% u grupi I, 15% u grupi II i 45% u grupi III. Kod melanoma debljih od 4 mm, 15% bolesnika imalo je lažno negativni rezultat UZ ATI. Senzitivnost UZ ATI za sve bolesnike bila je 50%: u grupi I 0%; grupi II 33,3%; u grupi III 66,6%. Specifičnost metode za sve bolesnike bila je 100%, a tačnost 88%: grupa I 90%, grupa II 90%; grupa III 85%. Otkrivanje mikrometastaza UZ ATI i BLČS bilo je značajno veće kod melanoma debljine veće od 4 mm prema Breslow-u (grupa III) u poređenju sa tankim i intermedijarnim tumorima. Zaključak. Metod UZ ATI limfnih čvorova stražara prema senzitivnosti ima mesto u dijagnostici mikrometastaza u regionalnim limfnim čvorovima samo kod debelih melanoma, ali ne i kod tankih i intermedijarnih melanoma. Rezultati moraju biti potvrđeni na većem broju bolesnika. Ako se ovo posmatranje potvrdi, može se racionalizovati lečenje bolesnika sa debelim melanomom, smanjujući im broj operacija i skraćujući im vreme dijagnostike.

Biografija autora

Jefta V Kozarski, Clinic for Plastic Surgery and Burns,Military Medical Academy, Belgrade, Serbia;Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Specijalista za plastičnu, rekonstruktivnu i estetsku hirurgiju

Reference

Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy. Br J Surg 2002; 89(10): 1223−7.

Schäfer-Hesterberg G, Schoengen A, Sterry W, Voit C. Use of ultra-sound to early identify, diagnose and localize metastases in melanoma patients. Exp Rev Anticanc Ther 2007; 7(12): 1707−16.

Šijan G, Kozarski J, Stefanović D, Lalković M, Milićević S, Stanković G. Ultrasonographic findings validity in the identification of metastatic regional lymph nodes in patients with cutaneous melanoma. Vojnosanit Pregl 2010; 67(1): 25−31. (Serbian)

Voit CA, van Akkooi AC, Eggermont AM. Role of Ultrasound in the Assessment of the Sentinel Node of Melanoma Patients. AJR Am J Roentgenol 2010; 195(6): 474−5.

Catalano O, Setola SV, Vallone P, Raso MM, d'Errico Adolfo G. Sonography for locoregional staging and follow-up of cutaneous melanoma: how we do it. J Ultrasound Med 2010; 29(5): 791−802.

Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, et al. Targeted High-Resolution Ultrasound Is Not an Effective Substitute for Sentinel Lymph Node Biopsy in Patients With Primary Cutaneous Melanoma. J Clin Oncol 2009; 27(33): 5614−9.

Kunte C, Schuh T, Eberle JY, Baumert J, Konz B, Volkenandt M, et al. The use of high-resolution ultrasonography for preopera-tive detection of metastases in sentinel lymph nodes of pa-tients with cutaneous melanoma. Dermatol Surg 2009; 35(11): 1757−65.

Tschammler A, Wirkner H, Ott G, Hahn D. Vascular patterns in reactive and malignant lymphadenopathy. Eur Radiol 1996; 6(4): 473−80.

Cafiero F, Peressini A, Gipponi M, Rainero ML, Villa G, Sertoli MR, et al. Sentinel node biopsy in patients with cutaneous me-lanoma. Semin Surg Oncol 1998; 15(4): 284−6.

Glass FL, Cottam JA, Reintgen DS, Fenske NA. Lymphatic map-ping and sentinel node biopsy in the management of high-risk melanoma. J Am Acad Dermatol 1998; 39(4 Pt 1): 603−10.

Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic map-ping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999; 17(3): 976−83.

Balch CM, Gershenwald JE, Soong S, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27(36): 6199−206.

Stebbins WG, Garibyan L, Sober AJ. Sentinel lymph node biopsy and melanoma: 2010 update: Part I. J Am Acad Dermatol 2010; 62(5): 723−34.

Bogdanov-Berezovsky A, Pagkalos VA, Silberstein E, Shoham Y, Xanthinaki AA, Krieger Y. Increasing the Efficacy of SLNB in Cases of Malignant Melanoma Located in Close Proximity to the Lymphatic Basin. ISRN Dermatol 2014; 2014: 920349.

Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, et al. Validation of the accuracy of intraoperative lymphat-ic mapping and sentinel lymphadenectomy for early-stage me-lanoma: a multicenter trial. Multicenter Selective Lymphade-nectomy Trial Group. Ann Surg 1999; 230(4): 453−65.

Wasserberg N, Tulchinsky H, Schachter J, Feinmesser M, Gutman H. Sentinel-lymph-node biopsy (SLNB) for melanoma is not complication-free. Eur J Surg Oncol 2004; 30(8): 851−6.

Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G. ESMO Guidelines Working . Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl 7): vii86−vii91.

Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline.Update 2012. Eur J Cancer 2012; 48(15): 2375−90.

Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, et al. S3-Guideline “Diagnosis, therapy and follow-up of melanoma” - short version. J Dtsch Dermatol Ges 2013; 11(6): 563−602.

NCCN Clinical Practice guidelines in oncology v2. 2014. Available from: http://www.nccn.org/professionals/physician_gls/ pdf/melanoma.pdf.

Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand. 2010. Available from: www. publications /_files_nhmrc/ /attachments/cp111.pdf.

Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol 2012; 30(23): 2912−8.

Chakera AH, Hesse B, Burak Z, Ballinger JR, Britten A, Caracò C, et al. EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging 2009; 36(10): 1713−42.

Reintgen D, Pendas S, Jakub J, Swor G, Giuliano R, Bauer J, et al. National trials involving lymphatic mapping for melanoma: the Multicenter Selective Lymphadenectomy Trial, the Sunbelt Melanoma Trial, and the Florida Melanoma Trial. Semin On-col 2004; 31(3): 363−73.

Rajovic M, Jaukovic L, Kandolf-Sekulovic L, Šijan G, Zolotarevski L, Novakovic M. Sentinel lymph node status -clinicopathological and prognostic associations - initial experience from the single center. 6th World Meeting of Interdisciplinary Melanoma/Skin Cancer Centres & 8th EADO Congress; 2012 November 14−17; Barcelona, Spain: European Academy of Dermatology and Venerology; 2012.

Rajovic M, Jaukovic L, Zolotarevski L, Šijan G, Novakovic M. Sen-tinel lymph node tumor burden and its correlation to clinico-pathologic characteristics of primary melanoma and fi nding of non-sentinel lymph node in completelymph node dis-section. J Dtsch Dermatol Ges 2013;11(Suppl 7): 63−4.

Testori A, Rastrelli M, de Fiori E, Soteldo J, Vigna PD, Trifirò G, et al. Radio-guided ultrasound lymph node localization: feasibility of a new technique for localizing and excising nonpalpable lymph nodes ultrasound suspicious for melanoma metastases. Melanoma Res 2010; 20(3): 197−202.

Voit C, van Akkooi AC, Schafer-Hesterberg G, Schoengen A, Ko-walczyk K, Roewert JC, et al. Ultrasound Morphology Criteria Predict Metastatic Disease of the Sentinel Nodes in Patients With Melanoma. J Clin Oncol 2010; 8(5): 847−52.

Murali R, Thompson JF, Uren RF, Scolyer RA. Fine-needle biopsy of metastatic melanoma: clinical use and new applications. Lancet Oncol 2010; 11(4): 391−400.

Voit CA, van Akkooi AC, Schafer-Hesterberg G, Schoengen A, Schmitz PI, Sterry W, et al.. Rotterdam Criteria for Sentinel Node (SN) Tumor Burden and the Accuracy of Ultrasound (US) -Guided Fine-Needle Aspiration Cytology (FNAC): Can US-Guided FNAC Replace SN Staging in Patients With Mela-noma. J Clin Oncol 2009; 27(30): 4994−5000.

Doubrovsky A, Scolyer RA, Murali R, McKenzie PR, Watson GF, Lee SC, et al. Diagnostic Accuracy of Fine Needle Biopsy for Metastatic Melanoma and Its Implications for Patient Man-agement. Ann Surg Oncol 2007; 15(1): 323−32.

Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, et al. Targeted High-Resolution Ultrasound Is Not an Effective Substitute for Sentinel Lymph Node Biopsy in Patients With Primary Cutaneous Melanoma. J Clin Oncol 2009; 27(33): 5614−9.

Starritt EC, Uren RF, Scolyer RA, Quinn MJ, Thompson JF. Ultra-sound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg On-col 2005; 12(1): 18−23.

Voit C, Kron M, Schäfer G, Schoengen A, Audring H, Lukowsky A, et al. Ultrasound-guided Fine Needle Aspiration Cytology prior to Sentinel Lymph Node Biopsy in Melanoma Patients. Ann Surg Oncol 2006; 13(12): 1682−9.

Voit CA, Gooskens SL, Siegel P, Schaefer G, Schoengen A, Röwert J, et al. Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients. Eur J Cancer 2014; 50(13): 2280−8.

Voit CA, van Akkooi AJ, Schäfer-Hesterberg G, Sterry W, Eggermont AM. The value of preoperative ultrasound (after lym-phoscintigraphy) in conjunction with pre-sentinel lymph node biopsy fine-needle aspiration outweighs the usage of ultra-sound alone in conjunction with lymphoscintigraphy: the need for an algorithm. Melanoma Res 2010; 20(4): 357−9.

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2017/03/08
Broj časopisa
Vol. 73 Br. 10 (2016)
Rubrika
Originalni članak