Linfocintigrafia e biópsia de linfonodos-sentinela, com usoisolado de radiofármaco em dose única, no melanoma cutâneo

• Ano de defesa: 2007
• Autor(a) principal: Jose Carlos Ribeiro Resende Alves
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais
• Palavras-chave em Português: Compostos radiofarmacêuticos; Linfonodos; Melanoma; Cintilografia; Biópsia; Biópsia do linfonodo sentinela; Dose única; Cirurgia
• Link de acesso: https://hdl.handle.net/1843/ECJS-7DPQVX

Since 1992, sentinel lymph node biopsy is used in cutaneousmelanoma, breast cancer and other tumors with great capacity to metastasize. An adequate lymphatic mapping became mandatory in order to localize the appropriate nodes to be removed. In this procedure, the main part of the authors used different radiotracers, combined with different vital dyes and gamma-probe guided operation. Isosulphan blue and patent blue were the most frequently used dyes. Adverse anaphylatic reactions, sometimes life-threatening, were reported associated with theuse of these substances. Fifty consecutive cases of head and neck, limbs and trunk cutaneous melanoma, stages I and II of the American Joint Committee on Cancer , were operated on from December 1999 to march 2006, using single dose of 99Tc labeled sodium phytate for lymphatic mapping and sentinel-node biopsy. Fifty six lymphatic basins were studied. The sentinel lymph node biopsies were performed undergeneral, regional or local anesthesia, at the same time of wide resection of the primary lesions. In all cases, one or more sentinel lymph nodes were observed in lymphatic mapping, without the use of any dye. All sentinel lymph nodes found in lymphoscintigraphy were removed for biopsy, using gamma-probe guided surgery. The sensitivity of lymphatic mapping and sentinel lymph node biopsy, in this series, was 100%. In 50 patients, 56 basins were studied and 44 of them were negative.Thirteen patients presented with positive sentinel nodes, one of them with melanoma only in an interval lymph node. Thirty six patients with negative lymph node biopsy, comprising 43 lymphatic basins, observed from ten to 72 months, for an average of 36,86 months, remained without clinically detectable lymphatic metastases. There was one case of false-negative. This patient was submitted to axillary sentinel nodebiopsy and presented recurrence in supraclavicular node 11 months later. Eighteen months later, besides visceral metastasis, presented with recurrence in ipsilateral axilla. The specificity of the method was 98% in this series. In one case, adverse reaction to the radiotracer was observed in lymphatic mapping with the presence of erythema, pruritus and an 3 mm ulcer. In this patient, the sentinel node biopsy was postponed for 15 days, with the need of an extra dose of radiotracer. In 49 patients the biopsies were performed with the same dose of radiotracer used in lymphatic mapping. In all cases, lymphatic mapping and sentinel lymph biopsy was safely performed with tecnetium labeled sodium phytate, without vital dyes. No serious complications were observed. Interval and ectopic lymph nodes were easily detected. False-negative rate was 2%.