摘要目的 探讨常规HE及免疫组织化学染色在确定恶性黑色素瘤前哨淋巴结(SLN)转移率方面的差异,进一步研究 SLN中转移负荷与非前哨淋巴结(NSLN)转移的相关性.方法 收集2010至2016年间于复旦大学附属肿瘤医院进行SLN活检并行免疫组织化学(S-100蛋白、HMB45、Melan A、SOX10)检查的126例恶性黑色素瘤病例,分别统计常规HE染色和联合免疫组织化学检查确定SLN转移率的情况.对其中39例进行区域淋巴结清扫的病例,采用转移灶最大径、转移灶距被膜距离及转移灶组织学位置三种分级方法评估SLN转移负荷,分别统计各组之间的NSLN转移率有无差异.结果 126例病例中,仅通过HE染色确定SLN转移的为33例(阳性率26.2%),联合使用免疫组织化学检查可确定SLN转移的为49例(阳性率为38.3%),联合免疫组织化学检查与常规HE染色相比可提高SLN阳性检出率(12.1%).其中S-100蛋白阳性率98.0%(48/49),HMB45阳性率93.9%(46/49),Melan A阳性率为96.0%(47/49),SOX10阳性比例为8/8.39例进行区域淋巴结清扫的病例中,6例结果为阳性,得出SLN阳性时NSLN的转移率约为15.4%(6/39).SLN转移负荷分级评价统计结果显示,SLN转移灶最大径≤2 mm病例组与>2 mm病例组相比,NSLN转移率显著降低(P=0.042),且转移灶最大径<0.2 mm的8例病例NSLN结果均为阴性.结论 免疫组织化学检查可有效提高恶性黑色素瘤患者 SLN阳性检出率.SLN转移负荷分组研究显示转移灶最大径≤2 mm时,NSLN转移率显著降低,但对于哪一类SLN阳性患者可以安全的免除区域淋巴结清扫,需要更多大样本前瞻性试验进一步研究.

abstractsObjective To investigate the difference between routine hematoxylin-eosin(HE) staining and immunohistochemistry in diagnosing metastatic melanoma in sentinel lymph node(SLN) metastases,and to evaluate the association of SLN tumor burden with the status of non-sentinel lymph nodes (NSLN). Methods 126 melanoma patients were treated with SLN biopsy and further examined with immunohistochemistry at Fudan University Shanghai Cancer Center between 2010 and 2016,and the status of SLN was respectively estimated by HE stain and immunohistochemistry(S-100 protein, HMB45, Melan A and SOX10). In 39 patients who were treated with complete lymph node dissection, characteristics of SLN tumor burden(maximum diameter of the tumor deposit, tumor penetrative depth and the microanatomic location of the metastasis)and the associations of SLN tumor burden with the involvement of NSLN were all evaluated.Results Of the total 126 cases, 33(26.2%)were positive by HE staining and 49(38.3%) were positive by immunohistochemistry. S-100 protein was positive in 48 out of 49 cases(98.0%). HMB45 was positive in 46 out of 49 cases(93.9%). Melan A was positive in 47 out of 49 cases(96.0%). SOX10 was positive in 8 out of 8 cases. The outcome indicated that the application of immunohistochemistry identified positive SLN missed by HE stain in about 12.1% of cases. Of the 39 patients who were treated with complete lymph node dissection,six showed metastases in NSLN. The frequency of metastases in NSLN was 15.4%(6/39)when SLN was positive. Additionally, the frequency of metastases in NSLN in cases with SLN metastatic deposits≤2 mm was significantly lower than that in cases with SLN metastatic deposits>2 mm;eight cases with SLN metastatic deposits <0.2 mm had no additional positive NSLN. Conclusions The findings suggest that immunohistochemistry could effectively improve the detection of positive SLN in melanoma. Cases with SLN metastatic deposits ≤2 mm are less likely to have further metastases in NSLN. There is a need for prospective large-population based studies to identify a subgroup of SLN positive patients who can safely be spared complete lymph node dissection.