对比分析彩色多普勒超声诊断肉芽肿性乳腺炎与乳腺浸润性导管癌

目的对比分析肉芽肿性乳腺炎(GLM)与乳腺浸润性导管癌(IDC)的超声特点。方法回顾性分析经病理检查证实的26例GLM与28例IDC的超声检查结果,分析其声像图特征。结果 GLM病灶形态多不规则、边界不清晰、血流信号中等或较丰富,与IDC较相似。GLM病灶L/T值明显高于IDC,53.85%(14/26)的GLM病灶后方回声增强,而35.71%(10/28)IDC病灶后方回声衰减,且IDC患者PSV、阻力指数值及腋窝淋巴结肿大发生率均明显高于GLM。本组26例GLM中,术前超声仅诊断4例为炎症,28例IDC术前超声检查均诊断为恶性肿瘤。结论 GLM与IDC的声像学表现既有相似之处,同时亦各具特征,详细检查、综合分析有助于提高术前诊断的准确率。     

甲状腺肿瘤的超声诊断分析

目的:探讨超声诊断甲状腺癌的声像特征及对甲状腺癌的诊断价值。方法:回顾性分析2014年11月—2015年10月手术治疗的80例(87枚结节)甲状腺结节患者的术前超声图像,以术后病理学检查结果作为标准计算超声检查诊断甲状腺癌的诊断学效能指标。结果:80例患者共检出87枚结节,其中良性结节33枚(37.93%),甲状腺癌结节54枚(62.07%);甲状腺癌结节的大小、结节纵横径比值、边界性质、内部回声性质、后方回声衰减情况、淋巴结肿大情况与甲状腺良性结节间均有统计学差异(P0.05)。超声鉴别诊断甲状腺癌的灵敏度为75.93%、特异度为75.76%、漏诊率为24.07%、误诊率为24.24%。结论:根据超声声像特征鉴别诊断甲状腺癌具有一定的临床价值,具有无创、经济、方便的优点。     

乳腺肿块术前超声诊断的评价

目的评价超声检查对乳腺肿块诊断的临床应用价值。方法对经手术病理证实的137例乳腺肿块与超声结果进行了回顾性对比分析。结果良、恶性肿块均以低回声型为主要图像表现;良、恶性两组间在形态、边界、包膜、后方回声、微小钙化斑检出率、血流检出率比较,差异均有统计学意义(P0.05)。腋窝转移性淋巴结以淋巴结肿大,内部低回声为声像图特征。结论以二维超声为基础,结合彩色多普勒血流显像以及腋窝淋巴结检查,可提高乳腺肿块的术前诊断符合率。     

超声检查对甲状腺癌颈部淋巴结转移的评估价值

目的探讨超声诊断对于甲状腺癌颈部淋巴结转移的术前评估价值。方法回顾性分析诊治的72例甲状腺癌患者,所有患者均于术前完善超声检测,术后接受病理学检查。比较甲状腺癌颈部淋巴结转移超声诊断与术后病理诊断的一致性,评估超声诊断对于甲状腺癌颈部淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率,比较超声检测指标中转移性淋巴结和非转移性淋巴结的各项指标(纵横比、内部囊变钙化、淋巴门血流、动脉流速、内部与周边血流、阻力指数)的差异。结果 (1)甲状腺癌颈部淋巴结转移超声诊断与术后病理诊断结果的差异无统计学意义(P0.05);(2)超声检测相对于病理检测的灵敏度为88.52%,特异度为92.31%,阳性预测值为94.74%,阴性预测值为83.72%,准确率为90.00%。采用Kappa一致性检验,Kappa值为0.830,一致性最强;(3)超声检测显示的114个转移性淋巴结与86个非转移性淋巴结相比,纵横比、内部囊变钙化、淋巴门血流、内部与周边血流、阻力指数等指标差异均存在统计学意义(P0.05)。结论超声检测对于甲状腺癌颈部淋巴结转移术前评估的灵敏度、准确度均较高,结果较为可靠。特别是对于检测中发现纵横比2、内部囊变钙化、淋巴门血流减少、内部与周边血流增多、阻力指数增加等情况时,更需高度重视。     

乳腺癌腋窝淋巴结转移的超声声像特点及诊断分析

目的:探讨乳腺癌腋窝淋巴结转移的超声声像特征及对其的诊断价值。方法:选取拟实施乳腺癌根治手术的167例乳腺癌患者作为研究对象,患者术前接受B超检查,检查腋窝淋巴结的边界、内部回声、淋巴结内血流信号、微小钙化灶、纵横径之比,并对转移与未发生转移的腋窝淋巴结进行比较,以手术后病理结果作为诊断金标准,探讨乳腺癌腋窝淋巴结转移的超声声像特征及诊断价值。结果:发生腋窝淋巴结转移的有82例患者,其边界不清、内部回声不均匀、淋巴结内血流信号丰富、具有微小钙化灶、纵横径之比1.5的检出率均高于未发生腋窝淋巴结转移的乳腺癌患者,差异均具有统计学意义(P0.01);发生腋窝淋巴结转移患者的血流阻力指数显著低于未发生腋窝淋巴结转移的患者(P0.05);超声诊断发现腋窝淋巴结转移患者的敏感性为74.39%、特异性为88.24%、漏诊率为25.61%、误诊率为11.76%。结论:乳腺癌腋窝淋巴结转移阳性的超声声像特征与阴性淋巴结有明显差异,利用超声作为早期诊断手段具有较高的临床实用价值。     

分化型甲状腺癌术前原发肿物超声特征与术后颈部淋巴结转移的关系

目的:探讨分化型甲状腺癌术前原发肿物超声特征与术后颈部淋巴结转移的关系。方法:回顾性分析2016年5月—2018年5月经手术病理证实为分化型甲状腺癌的217例患者临床资料,根据术后病理是否发生转移分为转移组(101例)和未发生淋巴结转移的对照组(116例)。计算术前超声表现诊断甲状腺癌颈部淋巴结转移的敏感度、特异度、准确性、阳性预测值、阴性预测值、漏诊率、误诊率;采用单因素和多因素分析方法统计分化型甲状腺癌颈部淋巴结转移的相关因素。结果:术前超声对分化型甲状腺癌颈部淋巴结转移的诊断敏感度、特异度、准确性、阳性预测值、阴性预测值、漏诊率、误诊率分别为91.1%(92/101)、94.8%(110/116)、93.1%(202/217)、93.9%(92/98)、92.4%(110/119)、8.9%(9/101)、5.2%(6/116)。转移组患者淋巴结收缩期最高流速和搏动指数均高于对照组,差异有统计学意义(P0.05)。两组阻力指数无统计学差异(P0.05)。转移组与对照组患者的性别与年龄的差异均无统计学意义(P0.05)。转移组原发肿物的部位、边缘、边界、内部回声、回声的均匀性与对照组均无统计学差异(P0.05),但原发肿物的数目、大小、纵横比、与被膜接触面积、微钙化、内部血流与对照组比较有统计学差异(P0.05)。Logistic回归分析结果显示,原发肿物侵犯甲状腺被膜、微钙化、内部血流丰富为分化型甲状腺癌患者颈部淋巴结转移的独立危险因素(P0.05),原发肿物数目、大小、纵横比与颈部淋巴结转移关系不明显(P0.05)。结论:分化型甲状腺癌原发肿物侵犯甲状腺被膜、微钙化、内部血流丰富为分化型甲状腺癌患者颈部淋巴结转移的高危因素,临床上针对此类患者,术前超声医生应更仔细地寻找淋巴结转移征象,外科医生应据此制定精准化、个性化的手术方案。     

皮肤纤维组织细胞瘤超声表现

目的探讨皮肤纤维组织细胞瘤(CFH)的超声表现。方法回顾性分析31例经病理证实为CFH患者的术前高频彩色多普勒超声检查资料,观察CFH的声像图特征及内部血流情况。结果 CFH病灶均为单发,超声表现为类圆形肿块24例(24/31,77.42%),不规则形肿块7例(7/31,22.58%);肿块位于皮肤层7例(7/31,22.58%),同时累及皮肤层及皮下层24例(24/31,77.42%);最大径≤15mm者29例(29/31,93.55%),最大径15mm者2例(2/31,6.45%);均无包膜(31/31,100%);边界清楚25例(25/31,80.65%),边界不清6例(6/31,19.35%);呈低回声或弱回声30例(30/31,96.77%),呈稍强回声1例(1/31,3.23%);回声均匀28例(28/31,90.32%),回声不均3例(3/31,9.68%)。2例(2/31,6.45%)病灶内可见钙化;1例(1/31,3.23%)病灶内可见液化;探头加压时,1例(1/31,3.23%)病灶稍发生形变。病灶内部血流信号Adler分级为0级26例(26/31,83.87%),1级2例(2/31,6.45%),2级1例(1/31,3.23%),3级2例(2/31,6.45%)。结论 CFH的声像图表现具有一定特征,病变多为单发、最大径≤15mm的低弱回声结节,边界清楚,形态规则,内部多回声均匀,血流信号多不丰富,超声检查有助于诊断CFH。     

高频彩色多普勒超声在小乳腺癌诊断中的价值

目的探讨高频二维超声及彩色多普勒血流成像(CDFI)诊断小乳腺癌的应用价值。方法回顾性分析经术后病理证实的小乳腺肿块(小于2.0cm)101例,其中小乳癌53例,乳腺良性病变48例。分别就二维超声声像图特征、CDFI等项指标进行对照分析,明确对诊断有肯定价值的诊断指标。结果二维超声检查中,乳腺癌与良性病变在形态、边界、包膜、内部回声、后方回声、纵横比、有无钙化等方面均有显著性差异。CDFI乳腺癌的血流检出率为90.57%,血流信号丰富,以Ⅱ～Ⅲ级为主(占83.02%)。腋窝转移性淋巴结是乳腺癌的间接征象。结论小乳腺癌的二维图像、CDFI及转移性腋窝淋巴结在诊断小乳腺癌上均有特征性表现。综合分析可大大提高小乳腺癌的诊断准确率。     

儿童常见睾丸生殖细胞肿瘤的超声表现和临床特征

目的:探讨儿童常见睾丸生殖细胞肿瘤(TGCT)的超声表现和临床特征。方法:回顾性分析2013年3月至2019年1月92例儿童TGCT的实验室检查、超声检查和临床资料,并采用受试者工作曲线(ROC)分析血清AFP值和肿瘤最大直径对肿瘤良恶性的诊断效能。结果:畸胎瘤是儿童最常见的睾丸肿瘤,超声提示畸胎瘤多为囊实混合性(25/40,62.5%)或实性肿块(12/40,32.5%);表皮样囊肿可见典型的"洋葱圈"征(6/18,33.3%)和包膜钙化征(4/18,22.2%);卵黄囊瘤(YST)多表现为等回声(11/26,42.3%)或低回声(8/26,30.9%)实性肿块,肿瘤均不伴钙化,部分YST(7/26,26.9%)肿瘤内部见囊性无回声。彩色多普勒血流显像大部分YST血流信号丰富(25/26,96.2%),所有表皮样囊肿和皮样囊肿内部均未见血流信号。采用ROC曲线分析显示,血清AFP值ROC曲线下面积为0.985,最佳截断值为124.2 ng/ml,AFP诊断良恶性肿瘤的敏感性、特异性分别为92.9%、93.7%;肿瘤最大直径ROC曲线下面积为0.796,最佳截断值为2.7 cm,肿瘤最大直径诊断良恶性肿瘤的敏感性、特异性分别为57.1%、93.7%。结论:不同病理类型儿童TGCT超声声像图有一定的特征性表现,儿童TGCT预后良好,当血清AFP≥124.2 ng/ml、肿瘤最大直径≥2.7 cm时应考虑根治性睾丸切除术。     

术前螺旋CT与MRI判断结直肠癌区域淋巴结转移与分期的应用价值比较

目的比较螺旋CT与MRI在判断结直肠癌区域淋巴结分期与转移中的价值。方法回顾性分析本院80例结直肠癌患者临床病历资料,所有患者术前均接受CT和MRI检查,以临床手术病理结果为金标准,分析两者与病理结果的一致性及分期诊断符合率、判断淋巴结转移的效能及预判淋巴结分期的能力。结果 80例患者手术共发现982枚淋巴结,其中N_0期61例,共738枚淋巴结,N_1期10例,共132枚淋巴结,N_2期9例,共112枚淋巴结。术前CT/MRI淋巴结分期诊断符合率与手术病理结果差异无统计学意义(P0.05)。CT与病理结果一致性较好(Kappa值=0.674,P=0.000),MRI与病理结果一致性满意(Kappa值=0.785,P=0.000),两者在淋巴结转移判断的准确性、灵敏度、特异度、阳性预测值及阴性预测值方面差异均无统计学意义(均P0.05)。CT、MRI预判结直肠癌淋巴结分期的AUC为0.884、0.960。结论螺旋CT与MRI对结直肠癌区域淋巴结分期诊断与病理结果一致性均良好,两者分期诊断符合率、淋巴结转移的诊断效能相当,MRI预判淋巴结分期能力较CT更优。     

SPECT/CT scans allow precise anatomical location of sentinel lymph nodes in breast cancer and redefine lymphatic drainage from the breast to the axilla

BackgroundHistorical studies of lymphatic drainage of the breast have suggested that the lymphatic drainage of the breast was to lymph nodes lying in the antero-pectoral group of nodes in the axilla just lateral to the pectoral muscles. The purpose of this study was to confirm this is not correct.MethodsThe hybrid imaging method of SPECT/CT allows the exact anatomical position of the sentinel lymph node (SLN) in the axilla to be documented during pre-operative lymphoscintigraphy (LS) in patients with breast cancer. We have done this in a series of 741 patients. The Level I axillary nodes were defined as anterior, mid or posterior. This was related to the anatomical location of the primary cancer in the breast.ResultsA SLN was found in the axilla in 97.8% of our patients. Just under 50% of SLNs located in the axilla were not in the anterior group and lay in the mid or posterior group of Level I axillary nodes. There was a SLN in a single node field in 460 patients (63%), two node fields in 261(36%), three node fields in 6 and four node fields in 1 patient.ConclusionAxillary lymphatic drainage from the breast is not exclusively to the anterior (or antero-pectoral) group of Level I nodes.SynopsisSPECT/CT lymphoscintigraphy shows that the breast does not always drain to the anterior group of Level I lymph nodes in the axilla but may drain to the mid axilla and/or posterior group in about 50% of patients with breast cancer regardless of the location of the cancer in the breast. These data redefine lymph drainage from the breast to axillary lymph nodes.     

超声引导下细针穿刺细胞学检查诊断不同大小颈部淋巴结

目的探讨超声引导下细针穿刺抽吸细胞学检查(US-FNAC)对不同大小颈部淋巴结的定性诊断价值。方法回顾性分析130例患者共142个颈部淋巴结的US-FNAC资料,并与术后病理检查或临床随访最终确诊结果对照。将142个淋巴结按其短径分为A组(5mm)、B组(5~10mm)及C组(10mm),进行统计学分析。结果 US-FNAC诊断阳性淋巴结65个(恶性58个,可疑恶性7个),阴性淋巴结77个(良性59个,不确定及不满意18个);经术后病理检查或临床随访最终确诊为恶性淋巴结70个,良性淋巴结72个。颈部淋巴结US-FNAC定性诊断敏感度、特异度、准确率、阳性预测值及阴性预测值分别为:A组,82.35%(14/17)、95.00%(19/20)、89.19%(33/37)、93.33%(14/15)、86.36%(19/22);B组,91.17%(31/34)、97.56%(40/41)、94.67%(71/75)、96.88%(31/32)、93.02%(40/43);C组,94.73%(18/19)、100%(11/11)、96.67%(29/30)、100%(18/18)、91.67%(11/12)。3组间敏感度、特异度、准确率、阳性预测值及阴性预测值差异均无统计学意义(P均0.05)。结论 US-FNAC为鉴别颈部淋巴结良恶性的有效手段,对不同大小的淋巴结均具有较高诊断效能。     

Pattern of Lymph Node Micrometastasis and Prognosis of Patients with Colorectal Cancer

Background: Studies of lymph node micrometastases in patients with colorectal cancer have ignored the prognostic significance of the number and level of lymph node micrometastases. The aim of this study was to clarify the prognostic significance of the status of lymph node micrometastases in histologically node-negative colorectal cancer.Methods: We used immunohistochemistry with anti-cytokeratin antibody CAM5.2 to examine 1013 lymph nodes in 42 patients (12 recurrent and 30 nonrecurrent) with histologically determined Dukes B colorectal cancer. Five serial 6-m sections were used for immunohistochemical staining. The frequency, tumor cell pattern, and number and level of lymph node micrometastases were compared between the recurrent and nonrecurrent groups.Results: Micrometastasis was confirmed in 16% (59/373) of lymph nodes in the recurrent group and 12% (77/640) of lymph nodes in the nonrecurrent group, and the frequency of lymph node micrometastases was 92% (11/12) in the recurrent group and 70% (21/30) in the nonrecurrent group. The tumor cell pattern in the metastatic lymph nodes was similar in the recurrent and nonrecurrent groups. Micrometastasis in four or more lymph nodes occurred more frequently in the recurrent group than in the nonrecurrent group (58% vs. 20%, P < .05), and micrometastasis to N2 or higher nodes occurred more frequently in the recurrent group than in the nonrecurrent group (92% vs. 47%, P < .01).Conclusions: The number and level of positive micrometastatic lymph nodes was significantly correlated with postoperative recurrence of histologically determined Dukes B colorectal cancer. This parameter is a useful prognostic indicator in histologically node-negative colorectal cancer and is helpful in planning adjuvant chemotherapy.     

乳腺三阴性非特殊型浸润性癌自动乳腺全容积成像特点

目的 观察乳腺三阴性非特殊型浸润性癌（IC-NST）自动乳腺全容积成像（ABVS）超声特点。方法 回顾性收集经术后病理证实的156例单发IC-NST患者，根据免疫组织化学结果将其分为三阴性（三阴性组）和非三阴性（非三阴性组），对比组间一般资料及ABVS表现。结果 156例中，病变位于左乳76例、右乳80例，三阴性30例（30/156，19.23%）、非三阴性126例（126/156，80.77%）。组间患者年龄、肿瘤体积、淋巴结转移差异均无统计学意义（P均>0.05）；病理组织学分级差异有统计学意义（P<0.001），病灶ABVS冠状面"汇聚征"及后方回声衰减差异有统计学意义（P均<0.05），而微钙化、边缘、形态、方位及Adler血流分级差异均无统计学意义（P均>0.05）。结论 乳腺三阴性IC-NST的ABVS表现有一定特征性，其中乳腺冠状面"汇聚征"及后方回声衰减相比非三阴性IC-NST较为少见。     

Most Important Lymph Node Information in Gastric Cancer: Multivariate Prognostic Study

Background: In gastric cancer, the level and number of lymph node metastases is useful for predicting survival, and there are several staging systems for lymph node metastasis. The aim of this study was to compare the several lymph node classifications and to clarify the most important lymph node information associated with prognosis using multivariate analysis.Methods: A total of 106 patients with histologically node-positive gastric cancer treated by radical gastrectomy and extended lymph node dissection (D2, D3) were studied. The level of lymph node metastasis was categorized simply as Level I nodes (perigastric, No.1–6), Level II nodes (intermediate, No.7–9), and Level III nodes (distant, No.10–16), irrespective of the tumor location. The Level II nodes included lymph nodes along the left gastric artery, common hepatic artery, and celiac trunk.Results: Overall 5-year survival rate was 51%. Univariate analysis showed that 5-year survival rate was significantly influenced by the level of positive nodes (P < .01), total number of positive nodes (P < .01), number of positive Level I nodes (P < .01), and number of positive Level II nodes (P < .01), in addition to the tumor location (P < .05), tumor size (P < .05), gross type (P < .01), and depth of wall invasion (P < .01). Of these, independent prognostic factors associated with 5-year survival rate were the number of positive Level II nodes (0–1 vs. 2) (62% vs. 19%, P < .01) and the depth of wall invasion (within vs. beyond muscularis) (79% vs. 43%, P < .01).Conclusions: Among several staging systems for lymph node metastases, the number of positive Level II nodes provided the most powerful prognostic information in patients with node-positive gastric cancer. When there were two or more metastases in the Level II nodes, prognosis was poor even after D2 or D3 gastrectomy.     

高频超声诊断乳腺佩吉特病的价值

目的观察高频超声对乳腺佩吉特病(PDB)的诊断价值。方法回顾性分析经病理证实的30例PDB患者的乳腺高频超声资料,其中13例合并浸润性导管癌(IDC),比较PDB合并与未合并IDC患者乳腺超声表现的差异。结果 PDB超声表现包括乳头内低回声、乳晕皮肤增厚、乳腺内结节、钙化、导管扩张及腋窝淋巴结肿大。PDB合并IDC患者超声显示结节率(P=0.001)及腋窝淋巴结肿大率(P=0.002)均高于未合并IDC者,超声显示二者乳腺影像报告和数据系统(BI-RADS)分类、乳头内低回声、乳晕皮肤增厚、钙化及乳腺导管扩张比例差异均无统计学意义(P均0.05)。结论 PDB超声表现具有一定特征性,高频超声有助于诊断及评估病情。     

Gastric cancer: factors affecting survival

Background and aim: The present multicenter, retrospective study aimed at determining the factors affecting survival in patients who were operated on due to gastric cancer (GC).

Patients and methods: The data of 234 patients, who underwent elective surgery due to GC were retrospectively analyzed. The demographic characteristics, tumor localization and diameter, type of resection and lymph node dissection, experience of the operating surgeon (senior or junior), tumor grade, pT stage, number of lymph nodes harvested, number of lymph nodes with and without metastasis, tumor stage and survival data were recorded.

Results: Survival was better a tumor diameter <4?cm, lower localization, experience of the operating surgeon (senior), without metastatic lymph nodes, tumor grade and decreased invasion depth (p?<?.05). There was no statistically significant difference between D1 LND and D2 LND with respect to survival (p?=?.793). Mortality was higher and survival was lower in patients with metastatic lymph nodes (p?=?.001). A number of harvested lymph nodes of 16 or more increased mortality (p?=?.003). Also, as disease stage increased, there was a decrease in survival and increase in mortality rates (p?=?.001).

Conclusions: Survival outcomes in resectable GCs are affected by the experience of the surgeon and patient-related factors at the time of surgery, including tumor size, T stage, and presence of metastatic lymph nodes.     

Abdominoperineal Resection via Total Mesorectal Excision and Autonomic Nerve Preservation for Low Rectal Cancer

p = 0.0003). Poorer survival was statistically related to the presence of positive lymph nodes ( p = 0.0009). Overall, local recurrence rates were 5% (8/148) in patients without distant metastases, and 15% to 21% in patients with positive nodes. Positive lymph nodes, N ₂ disease, lymphatic vascular invasion, and perineural invasion were independent significant risk factors for local recurrence. Sexual function was preserved in approximately 57% of patients undergoing APR versus 85% of patients undergoing sphincter preservation. No significant urinary morbidity was encountered. Low rectal cancer requiring APR seems to be a disease with more locally advanced disease and adverse pathologic features than are seen with mid-rectal cancers treatable by low anterior resection. APR when performed in accordance with the principles of TME and ANP ensures the greatest likelihood of resecting all regional disease while preserving both sexual and urinary functions. Preoperative combined modality treatment may be warranted in all T ₃ or greater low rectal cancers.     

Ratio Between Metastatic and Examined Lymph Nodes Is an Independent Prognostic Factor After D2 Resection for Gastric Cancer: Analysis of a Large European Monoinstitutional Experience

Background: In view of the lack of consensus on the level and number of lymph nodes to be examined for accurate staging of patients with gastric cancer, our aim was to evaluate the prognostic significance of lymph node status in a large European monoinstitutional experience.Methods: A review was made of our prospective database from 1980 to 2000, when 314 of 445 patients operated for gastric adenocarcinoma underwent radical resection (R0) with D2 lymphadenectomy. Survival was determined by the Kaplan-Meier method and differences were assessed by the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model in forward stepwise regression.Results: In 277 evaluable patients, 5-year survival was 57% (median follow-up, 48 months; range, 2–251). A total of 7668 lymph nodes were examined (median, 27; range, 11–62). The 5-year survivals according to the metastatic/examined lymph nodes ratio (N ratio) were 14%, 50%, 61%, and 82% in the group of patients with N ratio >25%, 11%–25%, 1%–10%, and 0%, respectively (P < .0001). At multivariate analysis, the N ratio was the best single independent prognostic factor (P = .000).Conclusions: After R0 resection for gastric cancer, the N ratio is a potent prognostic factor. It should therefore be considered in the clinical decision making process.Presented at the 56th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 5–9, 2003.     

Risk Factors for Nodal Recurrence After Lymphadenectomy for Melanoma

Background:The risk and outcome of regional failure after elective and therapeutic lymph node dissection (ELND/TLND) for microscopically and macroscopically involved lymph nodes without adjuvant radiotherapy were evaluated.Methods:Retrospective melanoma database review of 338 patients (ELND 85, TLND 253) from 1970 to 1996 with pathologically involved lymph nodes.Results:Regional recurrence occurred in 14% of patients treated with ELND (n = 12) and 28% of patients treated with TLND (n = 72; P = .009). Risk factors associated with nodal recurrence were advanced age, primary lesion in the head and neck region, depth of the primary lesion, number of involved lymph nodes, and extracapsular extension (ECE). For each nodal basin, the ELND group had a lower incidence of recurrence than the TLND group. The TLND group had larger lymph nodes, greater number of involved lymph nodes, and a higher incidence of ECE. The 10-year disease-specific survival was 51% vs. 30% for ELND and TLND, respectively (P = .0005). Nodal basin failure was predictive of distant metastasis, with 87% developing distant disease compared with 54% of patients without nodal recurrence (P < .0001). Of six patients who underwent a second dissection after isolated nodal recurrence, five patients have had a median disease-free interval of 79 months.Conclusions:After ELND or TLND, patients who have a large tumor burden (thick primary melanoma, multiply involved lymph nodes, ECE), advanced age, and a primary lesion located in the head and neck have a significantly increased likelihood of relapse and a decreased survival. Few patients present with an isolated nodal recurrence, but the majority can be salvaged by a second dissection.Presented at the Society of Surgical Oncology Cancer Symposium, New Orleans, Louisiana, March 16–19, 2000