About-cancer / diagnost-staging / staging / sentinel-node-biopsy-fact-sheet

Sentinel Lymph Node Zolemba

Kodi ma lymph node ndi chiyani?

Ma lymph lymph ndi ziwalo zing'onozing'ono zozungulira zomwe zimakhala mbali ya mitsempha ya m'thupi. Lymphhatic system ndi gawo la chitetezo chamthupi. Amakhala ndi zotengera ndi ziwalo zomwe zimakhala ndi lymph, madzi omveka bwino omwe amakhala ndi maselo oyera am'magazi komanso zotulutsa madzi ndi zinyalala zochokera m'maselo ndi minyewa ya thupi. Mwa munthu yemwe ali ndi khansa, ma lymph amathanso kunyamula maselo a khansa omwe achoka pachotupa chachikulu.

Anatomy ya mitsempha yodutsitsa madzi, yowonetsa ziwiya zam'mimba ndi ziwalo zam'mimba, kuphatikiza ma lymph node, matonil, thymus, ndulu, ndi mafupa Pamwamba pazithunzi pamakhala mawonekedwe am'mimba ndi zotengera zam'mimba, muli mivi yosonyeza momwe ma lymph ndi ma immune immune otchedwa ma lymphocyte amalowera ndikutuluka mu lymph node. Pansi pake pamakhala kutseka kwa fupa.

Lymph imasefedwa kudzera mu ma lymph node, omwe amapezeka kwambiri mthupi lonse ndipo amalumikizana wina ndi mnzake ndi zotengera zam'mimba. Magulu a ma lymph node amapezeka pakhosi, pansi pamimba, pachifuwa, pamimba, ndi m'mabako. Ma lymph node amakhala ndimaselo oyera (ma lymphocyte ndi ma lymphocyte a T) ndi mitundu ina yamaselo amthupi. Matenda am'mimba amatchera mabakiteriya ndi mavairasi, komanso ma cell owonongeka komanso achilendo, omwe amathandiza chitetezo cha mthupi kuthana ndi matenda.

Mitundu yambiri ya khansa imafalikira kudzera mumitsempha yamagazi, ndipo imodzi mwamasamba oyambilira a khansa iyi ndi ma lymph node apafupi.

Kodi sentinel lymph node ndi chiyani?

Sentinel lymph node imatanthauzidwa kuti ndi njira yoyamba yomwe ma cell a khansa amatha kufalikira kuchokera ku chotupa choyambirira. Nthawi zina, pamatha kukhala ma sentinel lymph node yopitilira imodzi.

Kodi sentinel lymph node biopsy ndi chiyani?

Sentinel lymph node biopsy (SLNB) ndi njira yomwe sentinel lymph node imadziwika, kuchotsedwa, ndikuwunikidwa kuti muwone ngati ma cell a khansa alipo. Amagwiritsidwa ntchito kwa anthu omwe adapezeka kale ndi khansa.

Zotsatira zoyipa za SLNB zikusonyeza kuti khansara siinafalikire kufikiliya kapena ziwalo zina zapafupi.

Zotsatira zabwino za SLNB zikuwonetsa kuti khansa ilipo mu sentinel lymph node ndipo itha kufalikira kuma lymph node ena oyandikira (otchedwa ma lymph node am'madera) ndipo, mwina, ziwalo zina. Izi zitha kuthandiza dokotala kudziwa gawo la khansa (kuchuluka kwa matenda m'thupi) ndikupanga njira yoyenera yothandizira.

Kodi chimachitika ndi chiyani pa SLNB?

Choyamba, sentinel lymph node (kapena node) iyenera kupezeka. Pochita izi, dokotalayo amabayira mankhwala a radiation, utoto wabuluu, kapena zonse ziwiri pafupi ndi chotupacho. Dokotalayo amagwiritsa ntchito kachipangizo kuti azindikire ma lymph node omwe ali ndi zinthu zowononga mphamvu kapena amayang'ana ma lymph node omwe amadetsedwa ndi utoto wabuluu. Sentinel lymph node ikapezeka, dokotalayo amatumbulira pang'ono (pafupifupi 1/2 inchi) pakhungu ndipo amachotsa mfundozo.

Nthendayi ya sentinel imayang'aniridwa ngati kuli khansa yamankhwala. Ngati khansa ipezeka, dokotalayo amatha kuchotsa ma lymph node owonjezera, mwina nthawi yomweyo kapena pochita opaleshoni yotsatira. SLNB itha kuchitidwa mopitilira kuchipatala kapena itha kufuna kukhala mchipatala kwakanthawi.

SLNB nthawi zambiri imachitika nthawi yomweyo chotupa chachikulu chimachotsedwa. Nthawi zina njirayi imathandizidwanso isanachitike kapena ngakhale itatha (kutengera kuchuluka kwa zotengera zam'mimba zomwe zasokonezedwa) kuchotsa chotupacho.

Kodi maubwino a SLNB ndi ati?

SNLB imathandiza madokotala kuyambitsa khansa ndikuyerekeza chiwopsezo chomwe ma cell a chotupa apanga kuthekera kufalikira mbali zina za thupi. Ngati sentinel node ilibe vuto la khansa, wodwala amatha kupewa kuchitidwa opaleshoni yayikulu kwambiri, kuchepetsa zovuta zomwe zingakhalepo chifukwa chokhala ndi ma lymph node ambiri.

Kodi zowopsa za SLNB ndi ziti?

Opaleshoni yonse yochotsa ma lymph node, kuphatikiza SLNB, imatha kukhala ndi zotsatirapo zoyipa, ngakhale kuchotsedwa kwa ma lymph node ochepa kumalumikizidwa ndi zovuta zochepa, makamaka zowopsa monga lymphedema. Zotsatira zoyipa ndizo:

• Lymphedema, kapena kutupa kwa minofu. Pochita ma lymph node, zotengera zam'mimba zopita ndi kuchokera ku sentinel node kapena gulu la ma node zimadulidwa. Izi zimasokoneza mayendedwe am'magazi kudzera mdera lomwe lakhudzidwa, zomwe zimatha kubweretsa kuchuluka kwamankhwala amadzimadzi omwe angayambitse kutupa. Lymphedema imatha kupweteketsa kapena kukhumudwitsa mdera lomwe lakhudzidwa, ndipo khungu lomwe likukula limatha kukhala lolimba kapena lolimba.

Kuopsa kwa lymphedema kumawonjezeka ndi kuchuluka kwa ma lymph node kuchotsedwa. Palibe chiopsezo chochepa pochotsa sentinel lymph node yokha. Pankhani ya kuchotsa ma lymph node mu mkono kapena kubuula, kutupa kumatha kukhudza dzanja lonse kapena mwendo wonse. Kuphatikiza apo, pamakhala chiopsezo chowonjezeka chotenga matenda m'dera lomwe lakhudzidwa kapena mwendo. Kawirikawiri, matenda otchedwa lymphedema chifukwa cha kuchotsedwa kwa ma lymph node angayambitse khansa ya mitsempha yotchedwa lymphangiosarcoma.

• Seroma, kapena misa kapena chotupa chomwe chimayambitsidwa ndi kuchuluka kwa madzi amadzimadzi pamalo opareshoni

• Dzanzi, kumva kulasalasa, kutupa, kufinya, kapena kupweteka pamalo opareshoni, komanso chiopsezo chowonjezeka cha matenda

• Zovuta kusuntha gawo lomwe lakhudzidwa

• Khungu kapena kusokonezeka kwa utoto wabuluu womwe umagwiritsidwa ntchito mu SNLB

• Zotsatira zabodza zotsutsana-ndiye kuti, ma cell a khansa sawoneka mu sentinel lymph node ngakhale atafalikira kale kumatenda am'magawo kapena mbali zina za thupi. Zotsatira zabodza zomwe zimapangitsa kuti wodwalayo komanso adotolo azindikire kuti ali ndi khansa mthupi la wodwalayo.

Kodi SLNB imagwiritsidwa ntchito kuthandiza mitundu yonse ya khansa?

Ayi. SLNB imagwiritsidwa ntchito kwambiri kuthandiza khansa ya m'mawere ndi khansa ya pakhungu. Nthawi zina amagwiritsidwa ntchito popanga khansa ya penile (1) ndi khansa ya endometrial (2). Komabe, ikuwerengedwa ndi mitundu ina ya khansa, kuphatikizapo khansa ya m'mimba ndi khomo lachiberekero (3), ndi mabakiteriya am'mimba, am'mimba, am'matumbo, mutu ndi khosi, chithokomiro, komanso khansa ya m'mapapo yosakhala yaying'ono (4).

Kodi kafukufuku wasonyeza chiyani pakugwiritsa ntchito SLNB mu khansa ya m'mawere?

Maselo a khansa ya m'mawere amatha kufalikira koyamba ku ma lymph node omwe amapezeka mu axilla, kapena m'khwapa, pafupi ndi bere lomwe lakhudzidwa. Komabe, mu khansa ya m'mawere pafupi ndi pakati pa chifuwa (pafupi ndi chifuwa cha m'mawere), maselo a khansa amatha kufalikira koyamba kumatenda amkati mkati mwa chifuwa (pansi pa chifuwa, chotchedwa mammary nodes) asanawonekere mu axilla.

Chiwerengero cha ma lymph node mu axilla chimasiyanasiyana malinga ndi munthu; mtundu wamba umakhala pakati pa 20 ndi 40. M'mbuyomu, ma axillary lymph node onse adachotsedwa (mu opaleshoni yotchedwa axillary lymph node dissection, kapena ALND) mwa azimayi omwe amapezeka ndi khansa ya m'mawere. Izi zidachitika pazifukwa ziwiri: kuthandiza kuthandizira khansa ya m'mawere ndikuthandizira kupewa matendawa mobwerezabwereza. (Kuchulukanso kwa khansa ya m'mawere kumachitika pomwe maselo a khansa ya m'mawere omwe asamukira ku ma lymph node apafupi amatulutsa chotupa chatsopano.)

Sentinel lymph node biopsy ya m'mawere. Mankhwala opangira ma radio ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho (gulu loyamba). Zinthu zojambulidwa zimapezeka zowoneka ndi / kapena ndi chida chomwe chimazindikira ma radioactivity (gulu lapakati). Ma sentinel (ma) (ma lymph node (oyamba) oti atenge zinthuzo) amachotsedwa ndikuwunika ngati ali ndi khansa (gawo lomaliza).

Komabe, chifukwa kuchotsa ma lymph node angapo nthawi imodzimodzi kumawonjezera chiopsezo cha zotsatirapo zoyipa, mayesero azachipatala adayambitsidwa kuti afufuze ngati ma lymph node a sentinel atha kuchotsedwa. Mayeso awiri azachipatala a 3 omwe amathandizidwa ndi NCI awonetsa kuti SLNB yopanda ALND ndiyokwanira kuthana ndi khansa ya m'mawere komanso kupewa kubwereranso kwa amayi omwe alibe zizindikilo zamankhwala a axillary lymph node metastasis, monga chotupa kapena chotupa pachikwama chomwe chingathe zimayambitsa kusapeza bwino, ndipo amathandizidwa ndi opareshoni, othandizira njira zamankhwala, komanso mankhwala a radiation.

Kuyesa kumodzi, kophatikiza azimayi a 5,611, ofufuza adapatsa mwayi ophunzira kuti alandire SLNB yokha, kapena SLNB kuphatikiza ALND, atachitidwa opaleshoni (5). Amayi omwe ali m'magulu awiriwa omwe ma cell am'magulu awo anali opanda khansa (okwanira azimayi 3,989) adatsatiridwa kwa zaka 8. Ofufuzawa sanapeze kusiyana pakati pakupulumuka konse kapena kupulumuka kwa matenda pakati pa magulu awiri azimayi.

Kuyesaku kunaphatikizaponso azimayi 891 omwe ali ndi zotupa mpaka 5 cm m'mawere ndi chimodzi kapena ziwiri zabwino za sentinel lymph node. Odwala amapatsidwa mwayi wopeza SLNB kokha kapena kulandira ALND pambuyo pa SLNB (6). Amayi onse amathandizidwa ndi lumpectomy, ndipo ambiri amalandiranso njira zowonjezerera ndi ma radiation kunja kwa bere lomwe lakhudzidwa. Pambuyo pakutsatiridwa kwanthawi yayitali, magulu awiriwa azimayi anali ndi moyo wazaka 10 zofananira, kupulumuka kopanda matenda, komanso kuchuluka kwakanthawi kwam'madera (7).

Kodi kafukufuku wasonyeza chiyani pakugwiritsa ntchito SLNB mu khansa ya pakhungu?

Kafukufuku akuwonetsa kuti odwala omwe ali ndi khansa ya khansa omwe adachitapo SLNB komanso omwe ma cell sentinel lymph node amapezeka kuti alibe khansa komanso omwe alibe zisonyezo zakuti khansa yafalikira ku ma lymph node ena amatha kupewedwa maopareshoni ochulukirapo nthawi ya chotupa chachikulu kuchotsa. Kusanthula kwa meta kwamaphunziro 71 okhala ndi chidziwitso kuchokera kwa odwala 25,240 adapeza kuti chiwopsezo cha kubwereza kwa lymph node kwa odwala omwe ali ndi SLNB yoyipa chinali 5% kapena kuchepera (8).

Sentinel lymph node biopsy mwa wodwala khansa ya khansa. Mankhwala opangira ma radio ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho (gulu loyamba). Zinthu zojambulidwa zimapezeka zowoneka ndi / kapena ndi chida chomwe chimazindikira ma radioactivity (gulu lapakati). Ma sentinel (ma) (ma lymph node (oyamba) oti atenge zinthuzo) amachotsedwa ndikuwunika ngati ali ndi khansa (gawo lomaliza). Sentinel lymph node biopsy imatha kuchitika musanachitike kapena mutachotsa chotupacho.

Zotsatira kuchokera ku Multicenter Selective Lymphadenectomy Trial II (MSLT-II) zidatsimikiziranso chitetezo cha SLNB mwa anthu omwe ali ndi khansa ya khansa yomwe ili ndi ma sentinel lymph node ndipo alibe umboni wazachipatala wokhudzidwa ndi ma lymph node ena. Kuyesa kwakukulu kwanthawi yayitali ya 3, komwe kunaphatikizapo odwala opitilira 1,900, kuyerekezera phindu lomwe lingachitike la SLNB kuphatikiza kuchotsedwa kwa ma lymph node (omwe amatchedwa kumaliza lymph node dissection, kapena CLND) ndi SNLB kuphatikiza kuyang'anira mwachangu, komwe kunaphatikizapo kuyezetsa magazi pafupipafupi kwa ma lymph node otsalawo ndi chithandizo cha CLND ngati zizindikiritso za metastasis zowonjezera zapezeka.

Pambuyo pakutsatiridwa kwapakatikati pa miyezi 43, odwala omwe adakumana ndi CLND sanakhale ndi moyo wabwino ngati melanoma kuposa omwe adakumana ndi SLNB ndi CLND pokhapokha ngati zizindikiro zowonjezera ma lymph node metastasis zikuwonekera (86% ya omwe akutenga nawo mbali m'magulu onsewa anali sanafe ndi khansa yapakhungu zaka zitatu) (9).

Zolemba Zosankhidwa

1. Mehralivand S, van der Poel H, Zima A, et al. Sentinel lymph node imaging mu urologic oncology. Kutanthauzira Andrology ndi Urology 2018; 7 (5): 887-902. [Adasankhidwa]
2. Renz M, Diver E, Chingerezi D, et al. Sentinel lymph node biopsies mu khansa ya endometrial: Chitani zochitika pakati pa azachipatala a azimayi ku United States. Zolemba pa Gynecology Yocheperako Kwambiri 2019 Apr 10. pii: S1553-4650 (19) 30184-0. [Adasankhidwa]
3. Reneé Franklin C, Tanner EJ III. Kodi tikupita kuti ndi sentinel lymph node mapping in gynecologic cancer? Malipoti Apano a Oncology 2018; 20 (12): 96. [Adasankhidwa]
4. Chen SL, Iddings DM, Scheri RP, Bilchik AJ. Kujambula kwa ma lymphatic ndikuwunika kwa ma sentinel: malingaliro apano ndi kugwiritsa ntchito. CA: Cancer Journal ya Madokotala 2006; 56 (5): 292-309. [Adasankhidwa]
5. Krag DN, Anderson SJ, Julian TB, ndi al. Sentinel-lymph-node resection poyerekeza ndi axillary-lymph-node dissection m'matenda omwe ali ndi khansa ya m'mawere: kupulumuka konse kochokera ku NSABP B-32 kuyeserera gawo lachitatu. Lancet Oncology 2010; 11 (10): 927-933. [Adasankhidwa]
6. Giuliano AE, Kuthamangira KK, Ballman KV, et al. Axillary dissection vs no axillary dissection mwa amayi omwe ali ndi khansa ya m'mawere yowopsa komanso sentinel node metastasis: kuyesa kwamankhwala kosasintha. JAMA: Magazini ya American Medical Association 2011; 305 (6): 569-575. [Adasankhidwa]
7. Giuliano AE, Ballman KV, McCall L, ndi al. Zotsatira zakuwonongeka kwa ma axillary vs no disill axillary pazaka 10 zapakati pa amayi omwe ali ndi khansa ya m'mawere yowopsa komanso sentinel node metastasis: ACOSOG Z0011 (Alliance) mayesero azachipatala. JAMA 2017; 318 (10): 918-926 (Pamasamba) [Adasankhidwa]
8. Valsecchi INE, Silbermins D, de Rosa N, Wong SL, Lyman GH. Mapu a Lymphatic and sentinel lymph node biopsy mwa odwala melanoma: kusanthula meta. Zolemba za Clinical Oncology 2011; 29 (11): 1479–1487. [Adasankhidwa]
9. Zovuta za MB, Thompson JF, Cochran AJ, et al. Kumaliza kusokoneza kapena kuwona kwa metinasis-node metastasis mu khansa ya pakhungu. New England Journal of Medicine 2017; 376 (23): 2211-2222. [Adasankhidwa]