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Schildwächterlymphknotenexzision (SLKE) und Positronenemissionstomographie (PET)

Staginguntersuchungen bei Melanompatienten in den klinischen Stadien I–II (nach DDG): Erfahrungen aus der Hautklinik Dortmund

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Zusammenfassung

Hintergrund

Wir berichten unsere Erfahrungen beim interdisziplinären Staging von 51 Melanompatienten in den Krankheitsstadien I–II (DDG) mittels Schildwächterlymphknotenexzision (SLKE) und Positronenemissionstomographie.

Patienten/Methoden und Ergebnisse

Die Tumordicke variierte zwischen 1,0 und 6,0 mm (Median 1,5 mm, Mittelwert 2,07 mm). Bei allen 51 Patienten konnte ein SLK exzidiert werden: Insgesamt wurden 80 SLK in 69 Lymphabstromgebieten gefunden. Bei 6 Patienten wurde ein entnommener SLK histologisch als "positiv" bewertet. In der anschließenden radikalen Lymphadenektomie wurden bei keinem dieser Patienten weitere LK mit Tumorzellbefall gefunden. Die bei insgesamt 40 Patienten präoperativ zum Metastasenausschluss durchgeführte PET konnte keine der bei der nachfolgenden SLKE gefundenen Mikrometastasen in den primären Lymphabstromgebieten identifizieren. Bei einer Nachbeobachtungszeit von 7–40 Monaten kam es bei insgesamt 3 Patienten zum Fortschreiten der Tumorerkrankung; bei 2 dieser 3 Patienten war ein positiver SLK gefunden worden.

Schlussfolgerungen

Nach dem derzeitigen Wissensstand ist die SLKE bei einer Primärtumordicke von ≥1 mm sinnvoll. Die PET ergibt für das Staging von Melanompatienten in den Stadien I und II keine Zusatzinformation für frühe Metastasierung.

Abstract

Background and Objective

Sentinel lymph node excision (SLNE) and positron emission tomography (PET) were evaluated in the staging of 51 Stage I and II melanoma patients (staged according to the guidelines of the German Dermatological Society).

Patients/Methods and Results

Tumor thickness ranged from 1,0 mm to 6,0 mm (median: 1,5 mm; mean: 2,07 mm). At least one sentinel lymph node (SLN) was excised in all patients; 80 SLN were excised from 69 lymphatic drainage areas. Positive SLN were detected in 6 patients (11,8%). Additional positive lymph nodes were not detected in any of these patients in the following complete lymph node dissection of the affected lymph node basin. Preoperative PET was performed in 40 patients and did not detect any of the micrometastases that were subsequently found by SLNE. During the follow up of 7–40 months (mean 21,9 months) 3 patients experienced tumor progression; 2 of 3 had a positive SLN.

Conclusions

Acccording to the current literature SLNE is recommended in primary tumors greater than 1 mm thickness. PET cannot be expected to give additional information in the staging of stage I–II patients.

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Authors and Affiliations

  1. Hautklinik, Klinikum Dortmund gGmbH und Lehrstuhl Dermatologie der Universität Witten/Herdecke

    A. Schäfer, R. A. Herbst, U. Beiteke, S. Lange-Ionescu & P. J. Frosch

  2. Chirurgische Klinik, Klinikum Dortmund gGmbH

    H. Treckmann & D. Löhlein

  3. Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin, Klinikum Dortmund gGmbH

    G. Thiemann & B. Theophil

  4. Pathologisches Institut, Klinikum Dortmund gGmbH

    E.-W. Schwarze

  5. Praxis für Radiologie, Leopoldstraße 10, 44147 , Dortmund

    H.-J. Bartels

  6. Hautklinik, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137 , Dortmund

    A. Schäfer

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  1. A. Schäfer
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A. Schäfer und R.A. Herbst trugen gleichermaßen zu der Publikation bei.

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Schäfer, A., Herbst, R.A., Beiteke, U. et al. Schildwächterlymphknotenexzision (SLKE) und Positronenemissionstomographie (PET). Hautarzt 54, 440–447 (2003). https://doi.org/10.1007/s00105-002-0453-6

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  • DOI: https://doi.org/10.1007/s00105-002-0453-6

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