Problematika detekce a biopsie sentinelové uzlinyu maligních melanomů a karcinomu prsu

Problems of Detection and Biopsy Examination of Sentinel Llymph Nodes in Malignant Melanomas andin Breast Carcinoma

Background.
Detection of SLN in some types of malignant tumors is important for the developing of a therapeuticstrategy, determining the stage and predicting prognosis. It is possible to avoid removal of whole groups of lymphnodes. We have three detection methods – lymphoscintigraphy, blue dye and gamma probe. The aim of this studywas to compare these methods in breast cancer and malignant melanoma patients, to compare three radiopharmaceuticals,to assess the detection of non-axillary SLN in breast cancer.Methods and Results. SLN were examined in 214 melanoma patients (94 men, average age 58,4 yrs; 120 women,average age 52,6 yrs), in 147 breast cancer patients (145 women and 2 men, average age 59,3 yrs). We usedcombination of lymphoscintigraphy, intraoperative blue dye and gamma probe. Lymphoscintigraphy was done withthree radiopharmaceuticals – Nanocis, Senti-Scint and Nanocoll. SLN were subjected to histological and immunohistochemicalexamination. The best success rate of detection of SLN was by means of lymphoscintigraphy and thelowest by blue dye. The differences among the three radiopharmaceuticals were not large, however, in averageNanocoll detected more SLNs in malignant melanoma patients. In the breast cancer patients the false-negative rateof SLN was 5,17 %, sensitivity 94,83 %, negative predictive value 96,7 %, accuracy 98 %, positive predictive value100 %, specificity 100 %.Conclusions. Parallel use of scintigraphy, gamma probe, and blue dye is the highly effective and indispensable forthe SLN detection. In breast cancer patients it is advisable to take biopsy samples from the displayed non-axillarySLNs for improving the effects of the method.

Key words:
sentinel lymph node, lymphoscintigraphy, surgical gamma probe, patent blue dye, breast cancer, malignantmelanoma.