Die „sentinel" Lymphonodektomie mittels Szintillationsdetektor

Abstract

For decades the results of elective lymph node dissection (ELND) are differently discussed, so that it is not definitely recommended at present the less so since the morbidity of this operation can't be neglected. Since the beginning of 1995 we practice a gamma-probe guided sentinel lymphonodectomy (SLNE) on patients with melanoma from a Breslow tumor thickness of 1 mm upward, after injecting a colloidal 99m-Tc labelled tin (II) - sulfide solution around the tumor or the scar, if the tumor has been excided before. By this method, that allows a selection of patients who according clinically to a stage I or II (UICC) but even histopathologically to a stage III and who are profiting of a removal of the regional lymph nodes, the sentinel node can be exactly localised, tissue-sparing removed at minimal complication rates and the completeness of the removal can be verified by measurements of the radioactivity. When finding metastases in the histopathological examination of the node a dissection of the whole region follows.

Sentinel lymphonodectomy in nonmelanoma skin malignancies

“…The sentinel lymph node (SLN), defined as the first tumour‐draining lymph node, is a sensitive tool to diagnose lymph node status 1 . Removal of this lymph node, called sentinel lymphonodectomy (SLNE), has been established in the management of patients with malignant melanoma and breast cancer 1–7 . Its prognostic value was shown for melanoma and has also been investigated in internal malignancies such as gastrointestinal and colorectal cancer, prostate cancer, nonsmall cell lung cancer, vulval cancer, nodular thyroid neoplasms and cancer of the mucous membranes in the head and neck region 8–14 …”

Prognostic and Therapeutic Implications of Sentinel Lymphonodectomy and S-Staging in Merkel Cell Carcinoma

“…Internationally established standards have recently been published for cutaneous malignancies [13]. At least for melanoma they guarantee that the histological status of the SLN is highly representative of the whole lymph node basin [11, 12, 16, 17, 25]. This enables precise staging of patients without the morbidity of ELND.…”

“…The details of the method used by us have been published elsewere [11, 12, 13, 14, 15, 16, 21, 22]. In short: the first step preoperatively was to perform lymphoscintigraphy using technetium 99 ( 99 Tc), sulfur or human albumin.…”

“…Based on our experiences with malignant melanoma [11, 12, 13, 15, 16, 17], we attempted to identify in this study which MCC patients would benefit from further regional surgery using the technique of SLNE. The procedure is based on the identification of the first lymph node draining the primary tumor site, the so-called SLN, by preoperative and intraoperative mapping of lymphatic channels.…”

“…Since MCC usually affects the elderly, most dermatosurgeons do not advocate elective lymph node dissection (ELND) due to its high rate of complications. The low-morbidity intervention of sentinel lymphonodectomy (SLNE) proved its efficiency in melanoma [11, 12, 13, 14, 15, 16, 17]to reliably identify those patients who can be spared radical lymph node dissection. The further metastatic risk of the other patients highly depends on the S stage (see below) of the sentinel lymph node (SLN).…”