Der Onkologe

, Volume 16, Issue 12, pp 1140–1149 | Cite as

Schildwächterlymphknotenbiopsie beim Melanom

  • I. Satzger
  • M. Klein
  • C. Löser
  • S. Reske
  • A. Kapp
  • R. Gutzmer
Leitthema
  • 64 Downloads

Zusammenfassung

Die Entfernung des Schildwächterlymphknotens (SLNE), häufig auch als Schildwächterlymphknotenbiopsie oder Sentinel-Node-Biopsie bezeichnet, beinhaltet die gezielte Entfernung des tumordrainierenden Lymphknotens nach vorheriger Markierung mittels Lymphabflussszintigraphie. Seit der ersten Beschreibung von Morton im Jahr 1990 hat sich die SLNE in vielen Zentren zur operativen Standardversorgung bei der Erstdiagnose fortgeschrittener Primärmelanome entwickelt. Durch die SLNE werden frühzeitig klinisch okkulte regionäre Lymphknotenmetastasen (Mikrometastasen) erkannt. Die histopathologische und immunhistochemische Detektion regionärer Mikrometastasen gibt wichtige Informationen über die Prognose der Patienten und kann bei der Entscheidung für eine weitere operative Versorgung und adjuvante Therapie hilfreich sein. Gleichzeitig wird die SLNE aber auch kritisch hinterfragt, da es bislang keinen Beweis dafür gibt, dass dadurch die Prognose der Melanompatienten verbessert wird. Dennoch wird die Durchführung einer SLNE in den aktuellen Leitlinien ab einer Primärmelanom-Tumordicke von 1 mm empfohlen, und der Status des Schildwächterlymphknotens wurde in die Klassifikation des Melanoms integriert.

Schlüsselwörter

Malignes Melanom Schildwächterlymphknotenbiopsie Lymphknoten Mikrometastasen Prognose 

Sentinel node biopsy in malignant melanoma

Abstract

Extirpation of the sentinel lymph node, often termed sentinel lymph node biopsy (SLNB), means the targeted extirpation of the tumor-draining lymph nodes after labeling of these nodes by lymph scintigraphy. Since the first description by Morton in 1990, SLNB has developed into a standard procedure for the primary care of thick melanomas in many centers. SLNB reveals clinically occult lymph node metastases (micrometastases). The histopathologic and immunohistochemical detection of micrometastases provides important prognostic information and can be helpful for further surgical and adjuvant treatment decisions. However, SLNB is also controversially discussed, since there is no evidence that SLNB improves the prognosis of the melanoma patients. Nevertheless, SLNB is recommended in the current German guidelines for melanoma patients with a tumor thickness of 1 mm or greater and the status of the sentinel node has been integrated into the melanoma classification.

Keywords

Malignant melanoma Sentinel lymph node biopsy Lymph node Micrometastases Prognosis 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • I. Satzger
    • 1
  • M. Klein
    • 2
  • C. Löser
    • 3
  • S. Reske
    • 4
  • A. Kapp
    • 1
  • R. Gutzmer
    • 1
  1. 1.Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH)Medizinische Hochschule Hannover (MHH)HannoverDeutschland
  2. 2.Abteilung für Mund-, Kiefer- und GesichtschirurgieFachklinik HornheideMünsterDeutschland
  3. 3.Hauttumorzentrum RheinpfalzHautklinik am Klinikum der Stadt Ludwigshafen/RheinLudwigshafen/RheinDeutschland
  4. 4.Klinik für NuklearmedizinUniversität UlmUlmDeutschland

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