Současný stav biopsie sentinelové uzliny u pacientů s melanomem

English version

Autoři: O. E. Nieweg ^1,2
Působiště autorů: Melanoma Institute Australia, North Sydney ¹; The Mater Hospital, North Sydney ²
Vyšlo v časopise: Rozhl. Chir., 2014, roč. 93, č. 10, s. 485-490.
Kategorie: Souhrnné sdělení

Souhrn

Sentinelová uzlina je definovaná jako spádová lymfatická uzlina na přímé dráze lymfatické drenáže od primárního tumoru. Biopsie sentinelové uzliny je invazivní a potenciálně komplexní diagnostický test, který vyžaduje značnou zručnost a zkušenost lékařů nukleární medicíny, chirurgů a patologů, kteří se touto metodou zabývají. Tento výkon přináší důležité informace o stádiu onemocnění. Status regionálních lymfatických uzlin je nejdůležitější prognostický factor u pacientů s klinicky lokalizovaným melanomem. Nedávno publikovaná závěrečná zpráva z první Multicentrické studii na selektivní lymfadektomii (MSLT-1) ukazuje, že biopsie sentinelové uzliny s následnou disekcí regionálních uzlin zlepšuje přežívání u pacientů s metastázami do uzlin z melanomu o střední tloušce podle Breslowa (1,2−3,5 mm). Počet falešně negativních výsledků je sice značný, ale dá se omezit zkušenostmi, precizní technikou a úzkou spoluprácí mezi zúčastněnými specialisty. Chirurgické odstranění sentinelových uzlin je spojeno s minimální morbiditou.

Biopsie sentinelové uzliny je nyní součástí standardního postupu u pacientů s melanomem střední tloušťky, a dá se o ní uvažovat u tenčích či tlustších melanomů. Nové detekční látky (tzv. tracery) lymfatických uzlin a inovativní zobrazovací techniky by měly dále zlepšit senzitivitu metody. Nyní, když jsou dostupné výsledky MSLT-1, je další otázkou, zda by pacienti s pozitivní sentinelovou uzlinou měli podstoupit další chirurgický výkon. Na tuto problematiku je zaměřena studie Minitub prováděna EORTC a studie MSLT-2. Do doby, než budou k dispozici výsledky těchto studií, je disekce regionálních uzlin doporučena u pacientů s metastázami sentinelových uzlin.

Klíčová slova:
melanom − review − biopsie sentinelové uzliny – staging − přežívání

Zdroje

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