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ʻO Sentinel Lymph Node Biopsy

He aha nā pūnana lymph?

ʻO nā pūnana lymph he mau ʻōpuni liʻiliʻi a ʻāpana ia o ka ʻōnaehana lymphatic o ke kino. ʻO ka ʻōnaehana lymphatic kahi ʻāpana o ka ʻōnaehana pale. Aia ia i kahi pūnaewele o nā kīʻaha a me nā mea i loaʻa ka lymph, kahi wai aniani e lawe i nā maʻi koko keʻokeʻo e hakakā ana i nā maʻi koko a me nā huahana a me nā ʻōpala o ke kino. I loko o ke kanaka me ka maʻi ʻaʻai, hiki i ka lymph ke lawe i nā hunaola maʻi ʻaʻai i haki mai ka tumo nui.

ʻO Anatomy o ka ʻōnaehana lymphatic, e hōʻike ana i nā kīʻaha lymph a me nā mea lymph, e like me nā lymph node, nā tonsils, thymus, spleen, a me ka iwi iwi. Hōʻike ka top inset i ke ʻano o ka lymph node a me nā kīʻaha lymph, me nā pua e hōʻike ana i ka neʻe ʻana o ka lymph a me nā hunaola i kapa ʻia nā lymphocytes i loko a puka i waho o ka lymph node. Hōʻike nā mea lalo i kahi kokoke o ka momona o ka iwi.

Hoʻomaʻemaʻe ʻia ʻo Lymph ma o nā lymph node, i loaʻa ākea ma loko o ke kino a pili i kekahi i kekahi e nā pahu lymph. Aia nā hui o nā lymph node i ka ʻāʻī, underarms, umauma, ʻōpū, a me nā ʻūlū. Loaʻa i nā lymph nodes nā keʻokeʻo koko keʻokeʻo (B lymphocytes a me T lymphocytes) a me nā ʻano ʻē aʻe o nā pūnaewele pale pale. Māhele nā ​​lymph nodes i nā koʻohune a me nā mea hoʻomaʻi, a me kekahi mau ʻinoʻino a hewa ʻole, e kōkua ana i ka ʻōnaehana pale pale i nā maʻi.

Hoʻolahalaha nā ʻano he nui o ka maʻi ʻaʻai ma o ka ʻōnaehana lymphatic, a ʻo kekahi o nā pūnaewele mua loa o ka pālahalaha ʻana no kēia mau maʻi maʻi he mau lymph node kokoke.

He aha ke kikowaena lymph sentinel?

Hoʻomaopopo ʻia kahi pūnana lymph sentinel ma ke ʻano he lymph node mua kahi e laha aku ai nā hunaola maʻi maʻi mai kahi tumo mua. I kekahi manawa, hiki ke ʻoi aku ma mua o hoʻokahi kōpena lymph sentinel.

He aha ka biopsy lymph node sentinel?

ʻO kahi biopsy lymph node sentinel (SLNB) kahi hana e ʻike ʻia ai, lawe ʻia ai, a nānā ʻia ai ka lymph node sentinel e ʻike ai inā aia nā hunaola maʻi ʻaʻai. Hoʻohana ʻia ia i ka poʻe i ʻike mua ʻia me ka maʻi ʻaʻai.

Kuhi kahi hopena maikaʻi ʻole SLNB ʻaʻole hoʻolaha ʻia ka maʻi ʻaʻai i nā lymph node a i ʻole nā ​​mea ʻē aʻe.

Kuhi kahi hopena SLNB maikaʻi i ka loaʻa ʻana o ka maʻi ʻaʻai i loko o ka node lymph sentinel a ua pālahalaha ʻia paha ia i nā lymph node kokoke (i kapa ʻia nā lymph node āpana) a, malia paha, nā mea ʻē aʻe Hiki i kēia ʻike ke kōkua i ke kauka e hoʻoholo i ke kahua o ka maʻi ʻaʻai (ka nui o ka maʻi i loko o ke kino) a hoʻomohala i kahi hoʻolālā lapaʻau kūpono.

He aha ka hana ma kahi SLNB?

ʻO ka mea mua, pono e loaʻa i ka sentinel lymph node (ai ʻole nā ​​pona). No ka hana pēlā, injtion kahi surgeon i kahi mea radioactive, kahi kala polū, a i ʻole ʻelua ma kahi kokoke i ka tumo. Hoʻohana ka mea hoʻopōpō i kahi hāmeʻa e ʻike i nā lymph node i loaʻa ka mea radioactive a i ʻole nānā i nā lymph node i poni ʻia me ka kala polū. I ka manawa e loaʻa ai ka node lymph sentinel, hana ka mea lapaʻau i kahi ʻoki liʻiliʻi (ma kahi o 1/2 iniha) i loko o ka ʻili ākea a hemo i ka piko.

Nānā ʻia ka piko sentinel no ka loaʻa ʻana o nā hunaola maʻi ʻaʻai e kahi mea maʻi maʻi. Inā loaʻa ka maʻi ʻaʻai, hiki i ke kaukipō ke wehe i nā lymph node hou, i ka wā o ke kaʻina hana biopsy like a i ʻole i ka wā o ke kaʻina hana. Hana ʻia ʻo SLNB ma kahi kumu maʻi kūloko a koi paha i kahi noho pōkole i ka haukapila.

Hana pinepine ʻia ʻo SLNB i ka manawa like e hemo ai ka tumo mua. I kekahi mau hihia hiki ke hana ʻia i ke kaʻina hana ma mua a ma hope paha (e like me ka nui o ka hoʻoliʻiliʻi o nā moku lymphatic) ka lawe ʻia ʻana o ka tumo.

He aha nā pōmaikaʻi o SLNB?

Kōkua ʻo SNLB i nā kauka pae i nā maʻi ʻaʻai a kuhi i ka makaʻu o ka hoʻomohala ʻana o nā tumola i ka hiki ke hoʻolaha aku i nā ʻāpana ʻē aʻe o ke kino. Inā maikaʻi ʻole ka node sentinel no ka maʻi ʻaʻai, hiki i ka mea maʻi ke hōʻalo i ke kaha ʻana o ka lymph node ʻoi aku ka nui, e hōʻemi ana i nā pilikia kūpono e pili ana me ka hemo ʻana o nā lymph node.

He aha nā mea e hiki ai i ka SLNB?

Hiki i nā ʻoki āpau e hemo i nā lymph node, me SLNB, ke loaʻa nā hopena ʻino, ʻoiai ʻo ka hemo ʻana o nā liʻiliʻi liʻiliʻi e hoʻopili pinepine ʻia me nā hopena ʻē aʻe, ʻo nā mea koʻikoʻi e like me ka lymphedema. Loaʻa nā hopena ʻē aʻe i:

• Lymphedema, a i ʻole ka puhū ʻana o nā ʻaʻa. I ka wā o ke kāpena lymph node, ʻokiʻoki ʻia nā kīʻaha lymph e alakaʻi ana i a mai ka piko sentinel a i ʻole ka hui o nā pona. Hoʻopilikia kēia i ke kahe maʻamau o ka lymph ma o ka wahi i hoʻopilikia ʻia, a e alakaʻi ʻia ai i kahi buildup maʻamau o ka wai lymph i hiki ke kumu i ka pehu. Hiki i ka Lymphedema ke hana i ka ʻeha a i ʻole ka hōʻoluʻolu ʻole i ka wahi i hoʻopilikia ʻia, a mānoanoa a paʻakikī paha ka ʻili pili.

Hoʻonui ka makaʻu o ka lymphedema me ka helu o nā lymph node i hemo. Aia ka liʻiliʻi o ka makaʻu me ka hemo ʻana o ka node lymph sentinel wale nō. I ke kumu o ka lawe ʻana i ka pona lymph ākea ma ka ʻūlima a i ke ʻūlū paha, hiki i ka ʻōhū ke hoʻopili i ka lima a i ʻole ka wāwae. Hoʻohui ʻia, nui aʻe ka makaʻi o ka maʻi i ka wahi i hoʻopilikia ʻia a i ʻole nā ​​lālā. Kākaʻikahi loa, lymphedema maʻi ma muli o ka lawe ʻana i ka lymph node he nui e loaʻa i kahi maʻi ʻaʻai o nā moku lymphatic i kapa ʻia ʻo lymphangiosarcoma.

• ʻO Seroma, a i ʻole ka nuipa a puʻupuʻu paha i hoʻokumu ʻia e ka paʻa ʻana o ka wai lymph ma ke kahua o ke ʻoki

• Numbness, tingling, pamamā, ʻeha, a ʻeha paha ma ke kahua o ke ʻoki, a me ka nui o ka maʻi o ka maʻi

• Ka paʻakikī e neʻe ana i ka ʻāpana o ke kino i hoʻopilikia ʻia

• ʻO ka ʻili a i ʻole nā ​​hopena maʻi i ka kala ʻulaʻula i hoʻohana ʻia ma SNLB

• ʻO kahi hopena biopsy wahaheʻe ʻole-ʻo ia hoʻi, ʻaʻole ʻike ʻia nā hunaola maʻi ʻaʻai i loko o ke kahena lymph sentinel ʻoiai ua pālahalaha ʻia i nā lymph node āpana a i ʻole nā ​​ʻāpana ʻē aʻe o ke kino. Hāʻawi kahi hopena biopsy hewa ʻole i ka mea maʻi a me ke kauka i kahi ʻano hoʻopunipuni e pili ana i ka nui o ka maʻi ʻaʻai i loko o ke kino o ka mea maʻi.

Hoʻohana ʻia ʻo SLNB e kōkua i ke kahua i nā ʻano maʻi ʻaʻai?

ʻAʻole hoʻohana mau ʻia ʻo SLNB e kōkua i ka maʻi ʻaʻai umauma pae a me ka melanoma. Hoʻohana ʻia ia i kekahi manawa e hoʻokumu i ka maʻi ʻaʻai penile (1) a me ka maʻi ʻaʻai endometrial (2). Eia nō naʻe, ke aʻo ʻia nei me nā ʻano maʻi ʻaʻai ʻē aʻe, e like me nā maʻi ʻehaʻeha a me nā cervical (3), a me nā colorectal, gastric, esophageal, ke poʻo a me ka ʻāʻī, thyroid, a me nā maʻi ʻāpā liʻiliʻi liʻiliʻi ʻole (4).

He aha ka noiʻi i hōʻike ai e pili ana i ka hoʻohana ʻana o SLNB i ka maʻi ʻaʻai umauma?

Hoʻolahalaha mua ʻia nā hunaola maʻi ʻaʻai i nā lymph node i loko o ka axilla, a i ʻole ka ʻāpana o ke kēpau, ma ka ʻaoʻao o ka umauma ʻeha. Eia nō naʻe, i nā maʻi ʻōpū o ka umauma kokoke i ka piko o ka umauma (kokoke i ka umauma), hiki ke pālahalaha mua ʻia nā hunaola maʻi maʻi i nā pūnana lymph ma loko o ka pahu (ma lalo o ka umauma, i kapa ʻia nā mammary node) ma mua o ka ʻike ʻia i ka axilla.

ʻO ka helu o nā lymph node i ka axilla ʻokoʻa mai kēlā me kēia kanaka; aia ka pae maʻamau ma waena o 20 a 40. ʻO ka mōʻaukala, ua hoʻoneʻe ʻia kēia mau lymph node axillary āpau (i kahi hana i kapa ʻia ʻo ka axillary lymph node dissection, a ʻo ALND) i nā wahine i ʻike ʻia me ka maʻi ʻaʻai umauma. Ua hana ʻia kēia no nā kumu ʻelua: e kōkua i ke kahua o ka maʻi ʻaʻai o ka umauma a e pale aku i ka hoʻi hou ʻana o ka maʻi i ka ʻāina. (Regional recurrence o ka umauma maʻi 'aʻai l occurs ke hiki i ka umauma maʻi' aʻai keena i ua neʻe i kokoke lymph node haawi mai i ka hou Tum.)

ʻO ka biopsy lymph node Sentinel o ka umauma. Hoʻokomo ʻia kahi mea lekiō a me / a i ʻole ke kala polū ma kahi kokoke i ka tumo (panela mua). Aia nā mea i injected i ka ʻike a / a i ʻole me kahi hāmeʻa e ʻike i ka lekiō (panina waena). Lawe ʻia nā node sentinel (nā (nā) lymph node (s) mua e lawe i nā mea) a nānā ʻia no nā hunaola maʻi ʻaʻai (paneli hope).

Eia nō naʻe, no ka hemo ʻana o nā lymph node he nui i ka manawa like e hoʻonui ai i ka hopena o nā hopena ʻino, ua hoʻokau ʻia nā hoʻokolohua hoʻokolohua e nānā inā hiki ke lawe ʻia nā lymph node sentinel. Ua hōʻike ʻia ʻelua mau hoʻokolohua hoʻokolohua kaulike NCI i kākoʻo ʻia e SLNB me ka ʻole o ALND i lawa no ka hoʻonohonoho ʻana i ka maʻi ʻaʻai umauma a no ka pale ʻana i ka hoʻi hou ʻana o ka ʻāina i nā wahine ʻaʻohe o lākou hōʻailona hōʻailona o ka axillary lymph node metastasis, e like me ka puʻupuʻu a huʻi paha i ka ʻelima e hiki kumu discomfort, a ʻo wai e mālama ʻia me ke ʻoki kino, adjuvant systemic therapy, a me radiation therapy.

I hoʻokahi hoʻokolokolo, e pili ana i nā wahine he 5,611, ua koho kaulike nā mea noiʻi i nā mea komo e loaʻa wale iā SLNB, a i ʻole SLNB a me ALND, ma hope o ke kahakaha ʻana (5). ʻO kēlā mau wahine i nā hui ʻelua nona ka sentinel lymph node (s) i maikaʻi ʻole no ka maʻi ʻaʻai (kahi 3,989 wahine) a laila ukali ʻia no ka awelika o 8 mau makahiki. ʻAʻole i loaʻa i nā mea noiʻi he ʻokoʻa i ke ola holoʻokoʻa a i ʻole ola ola ʻole ma waena o nā hui ʻelua o nā wahine.

ʻO ka hoʻokolokolo ʻē aʻe i komo nā wahine 891 me nā tumors a i 5 cm i ka umauma a hoʻokahi a ʻelua paha mau lymph node sentinel maikaʻi. Ua hāʻawi kaulele ʻia nā mea maʻi e loaʻa iā SLNB wale nō a i ʻole e loaʻa iā ALND ma hope o SLNB (6). Ua mālama ʻia nā wahine āpau me ka lumpectomy, a ʻo ka hapanui hoʻi i loaʻa ka ʻōnaehana ʻōnaehana adjuvant a me ka radiation radiation radiation i waho i ka umauma ʻeha. Ma hope o ka hoʻonui ʻana o ka ukali ʻana, ua like nā hui ʻelua o nā wahine i ke ola holoʻokoʻa he 10 mau makahiki, ke ola me ka maʻi ʻole, a me nā helu hou ʻana o ka ʻāina (7).

He aha ka noiʻi i hōʻike ai e pili ana i ka hoʻohana ʻana o SLNB i melanoma?

Hōʻike ka noiʻi i nā maʻi me ka melanoma i loaʻa iā SLNB a nona ka sentinel lymph node i ʻike ʻia he maikaʻi ʻole no ka maʻi ʻaʻai a ʻaʻohe o lākou hōʻailona hōʻailona ua pāhola ka maʻi ʻaʻai i nā lymph node ʻē aʻe hiki ke mālama ʻia i ka ʻoki ʻana i ka lymph node ʻoi aku ka nui i ka manawa o ka tumo mua. ka hemo ʻana Ua hōʻike ʻia kahi meta-analysis o 71 mau hoʻopaʻa me nā ʻikepili mai nā 25,240 mau mea maʻi i loaʻa i ka pilikia o ka hoʻi hou ʻana o ka lymph node i nā mea maʻi me kahi SLNB maikaʻi ʻole he 5% a ʻoi aku paha (8).

ʻO ka biopsy lymph node Sentinel i kahi mea maʻi me ka melanoma. Hoʻokomo ʻia kahi mea lekiō a me / a i ʻole ke kala polū ma kahi kokoke i ka tumo (panela mua). Aia nā mea i injected i ka ʻike a / a i ʻole me kahi hāmeʻa e ʻike i ka lekiō (panina waena). Lawe ʻia nā node sentinel (nā (nā) lymph node (s) mua e lawe i nā mea) a nānā ʻia no nā hunaola maʻi ʻaʻai (paneli hope). Hiki ke hana i ka biopsy lymph node Sentinel ma mua a ma hope paha o ka hemo ʻana o ka tumo.

Loaʻa nā ʻike mai ka Multicenter Selective Lymphadenectomy Trial II (MSLT-II) i ka palekana o ka SLNB i ka poʻe me ka melanoma me nā lymph node sentinel maikaʻi a ʻaʻohe hōʻike hoʻokolohua o ke komo pū ʻana o ka lymph node. ʻO kēia hoʻokolohua hoʻokolohua hoʻokolohua 3 nui nui loa, kahi i hoʻopili ʻia ma mua o 1,900 mau mea maʻi, i hoʻohālikelike ʻia i ka pōmaikaʻi therapeutic Loaʻa o SLNB me ka lawe koke ʻia ʻana o nā koina lymph āpau i koe (i kapa ʻia ʻo ka hoʻopau ʻana o ka lymph node dissection, a i ʻole CLND) me SNLB me ka mākaʻikaʻi hana, i hoʻopili ke nānā ʻana i nā ultrasound o ke koena o nā lymph node āpana a me ka mālama ʻana me CLND inā ʻike ʻia nā hōʻailona o ka metastasis lymph node hou.

Ma hope o ka waena waena o 43 mau mahina, ʻo nā mea maʻi i loaʻa koke iā CLND ʻaʻole i loaʻa kahi ola melanoma kikoʻī ma mua o ka poʻe i loaʻa iā SLNB me CLND inā loaʻa nā hōʻailona o ka metastasis lymph node (86% o nā mea i komo i nā hui ʻelua i loaʻa. ʻaʻole i make mai melanoma ma 3 mau makahiki) (9).

Nā kūmole i koho ʻia

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2. Renz M, Diver E, English D, et al. ʻO biopsies o ka lymph node Sentinel i ka maʻi ʻaʻai endometrial: Hoʻomaʻamaʻa i nā lauana ma waena o nā oncologists gynecologic ma United States. Ka Nūpepa o Gynecology Minimally Invasive 2019 Apr 10. pii: S1553-4650 (19) 30184-0. [PubMed ʻAoʻao]
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6. Giuliano AE, Hunt KK, Ballman KV, et al. ʻO ka dissection axillary a me ka dissert axillary i nā wahine me ka maʻi kanesa umauma maʻi a me ka metastasis node sentinel. JAMA: Ka Palapala a ka American Medical Association 2011; 305 (6): 569-575. [PubMed ʻAoʻao]
7. Giuliano AE, Ballman KV, McCall L, et al. Ka hopena o ka dissection axillary vs no axillary dissection ma 10 makahiki holoʻokoʻa i waena o nā wahine me ka maʻi maʻi umauma maʻi a me ka sentinel node metastasis: ʻO ka ACOSOG Z0011 (Alliance) hoʻokolohua hoʻokolohua kaulike ʻole. JAMA 2017; 318 (10): 918-926. [PubMed ʻAoʻao]
8. ʻO Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Hoʻopaʻa Lymphatic a me ka biopsy lymph node sentinel i nā mea maʻi me ka melanoma: kahi meta-analysis. Ka Nūpepa o Oncology Clinical 2011; 29 (11): 1479-1487. [PubMed ʻAoʻao]
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