악성흑색종에서 감시림프절 생검술의 유용성 연구

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma.
Methods: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively.
Results: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (＋) group (5±2.9 ㎜) and SLN (?) group (4.5±5.0 ㎜) (P＜0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P＜0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema.
Conclusion: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.

목차 (Table of Contents)

• 서론
• 방법
• 결과
• 고찰
• 결론
• REFERENCES

참고문헌 (Reference)

1 배종면, "한국 8개 지역암등록본부 자료를 활용한 2000-2002년 한국인 국가 암통계 추정" 대한예방의학회 41 (41): 380-386, 2008

2 김철우, "전초림프절 절제술을 이용한 악성흑색종의 치료" 대한피부과학회 41 (41): 58-64, 2003

3 석주원, "유방암 환자의 전초림프절 검사에서 Tc-99m Tin-colloid와 Tc-99m Phytate의 효용성에 대한 비교" 대한핵의학회 42 (42): 451-455, 2008

4 오동석, "감시림프절 생검을 이용한 악성흑색종의 치험례" 대한성형외과학회 30 (30): 21-654, 2003

5 Morton DL, "Technical details of intraoperative lymphatic mapping for early stage melanoma" 127 : 392-399, 1992

6 Cuéllar FA, "Small cell melanoma and ulceration as predictors of positive sentinel lymph node in malignant melanoma patients" 14 : 277-282, 2004

7 Morton DL, "Sentinel-node biopsy or nodal observation in melanoma" 355 : 1307-1317, 2006

8 Thompson JF, "Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes" 5 : 255-260, 1995

9 Nowecki ZI, "Sentinel lymph node biopsy in melanoma patients with clinically negative regional lymph nodes--one institution's experience" 13 : 35-43, 2003

10 Koskivuo I, "Sentinel lymph node biopsy in cutaneous melanoma: a case-control study" 14 : 3566-3574, 2007

11 McMasters KM, "Sentinel lymph node biopsy for melanoma: controversy despite widespread agreement" 19 : 2851-2855, 2001

12 Rousseau DL Jr, "Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients" 10 : 569-574, 2003

13 Carlson GW, "Regional recurrence after negative sentinel lymph node biopsy for melanoma" 248 : 378-386, 2008

14 Vaggelli L, "Radioisotopic lymphatic mapping of the sentinel node in melanoma: importance of immunohistochemistry" 86 : 346-348, 2000

15 Balch CM, "Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system" 19 : 3622-3634, 2001

16 Chao C, "Patterns of early recurrence after sentinel lymph node biopsy for melanoma" 184 : 520-524, 2002

17 Li LX, "Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence: a clinicopathologic study of 1152 patients undergoing sentinel lymph node biopsy" 27 : 1197-1202, 2003

18 Yee VS, "Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy" 12 : 429-439, 2005

19 Gershenwald JE, "Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients" 17 : 976-983, 1999

20 Houghton AN, "Melanoma" 4 : 666-684, 2006

21 이태훈, "Lymphoscintigraphy와 전초 림프절 절제술을 이용한 피부 악성종양의 치험례" 대한성형외과학회 32 (32): 635-640, 2005

22 김홍석, "Lymphoscintigraphy와 Gamma-probe를 이용한 악성흑색종의 전초 림프절 생검 및 병기결정" 대한피부과학회 41 (41): 1575-1582, 2003

23 Niakosari F, "Lymphatic invasion identified by monoclonal antibody D2-40, younger age, and ulceration: predictors of sentinel lymph node involvement in primary cutaneous melanoma" 144 : 462-467, 2008

24 Sim FH, "Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study" 61 : 697-705, 1986

25 Rutkowski P, "Lymph node status and survival in cutaneous malignant melanoma--sentinel lymph node biopsy impact" 29 : 611-618, 2003

26 Doting MH, "Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma" 28 : 673-678, 2002

27 Gershenwald JE, "Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid" 124 : 203-210, 1998

28 Alex JC, "Gamma-probe-guided lymph node localization in malignant melanoma" 2 : 303-308, 1993

29 Coates AS, "Elective lymph node dissection in patients with primary melanoma of the trunk and limbs treated at the Sydney Melanoma unit from 1960 to 1991" 180 : 402-409, 1995

30 Jemal A, "Cancer statistics, 2008" 58 : 71-96, 2008