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Sentinel Lymph Node Biopsy

Chii chinonzi lymph node?

Lymph node idiki nhengo dzakatenderera dzinove chikamu chemuviri lymphatic system. Iyo lymphatic system chikamu che immune immune. Inoumbwa netiweki yemidziyo nenhengo dzine lymph, chinoyerera chakajeka chinotakura hutachiona-kurwisa machena masero eropa pamwe nezvinosvibisa uye marara zvigadzirwa kubva kumasero emuviri uye zvinyama. Mune munhu ane cancer, lymph inogona zvakare kutakura cancer maseru ayo akatsemuka kubva kune chikuru bundu.

Anatomy yeiyo lymphatic system, inoratidza iyo lymph midziyo uye lymph nhengo, kusanganisira lymph node, matonhe, thymus, spleen, uye mwongo wemapfupa. Pamusoro inset inoratidza chimiro cheiyo lymph node uye iyo lymph midziyo, iine miseve inoratidza kuti lymph uye immune maseru anonzi lymphocyte anopinda mukati uye kunze kweiyo lymph node. Pazasi mukati inoratidza kuswedera-kwepfupa remongo.

Lymph inosvinwa kuburikidza nema lymph node, ayo anowanikwa kwakawanda mumuviri wese uye akabatana kune mumwe nemumwe nemidziyo ye lymph. Mapoka ema lymph node ari mumutsipa, pasi pesimba, chifuva, dumbu, uye kugomera. Iwo ma "lymph node" ane masero machena eropa (B lymphocyte uye T lymphocyte) uye mamwe marudzi ema immune system maseru. Lymph node inobata mabhakitiriya nemavirusi, pamwe nemamwe maseru akakuvara uye asina kujairika, achibatsira immune system kurwisa hosha.

Mhando zhinji dzekenza dzinopararira kuburikidza neiyo lymphatic system, uye imwe yenzvimbo dzekutanga dzekupararira kwekenza idzi ndidzo nfu node dziri padyo.

Chii chinonzi sentinel lymph node?

Sentinel lymph node inotsanangurwa seyokutanga lymph node kune iyo maseru emukenza ingangopararira kubva kune yekutanga bundu. Dzimwe nguva, panogona kuve neanopfuura imwechete sentinel lymph node.

Chii chinonzi sentinel lymph node biopsy?

Sentinel lymph node biopsy (SLNB) inzira iyo iyo sentinel lymph node inozivikanwa, kubviswa, uye kuongororwa kuti ione kana masero emukenza aripo. Inoshandiswa muvanhu vakatowanikwa vaine cancer.

Mhedzisiro yakaipa yeSNNB inoratidza kuti gomarara harisati rapararira kune ma lymph node kana zvimwe nhengo.

Mhedzisiro yakanaka yeSNNB inoratidza kuti gomarara riripo mune sentinel lymph node uye kuti inogona kunge yakapararira kune mamwe ma lymph node ari pedyo (anonzi enharaunda node node) uye, pamwe, dzimwe nhengo. Ruzivo urwu runogona kubatsira chiremba kuona danho rekenza (huwandu hwechirwere mukati memuviri) uye nekuvandudza chirongwa chakakodzera chekurapa.

Chii chinoitika panguva yeslnb?

Kutanga, iyo sentinel lymph node (kana node) inofanira kuwanikwa. Kuti aite kudaro, chiremba anovhiya jekiseni chinhu chine radioactive, dhayi yebhuruu, kana zvese zviri zviviri padyo nebundu. Chiremba anovhiya anobva ashandisa chishandiso kuti aone lymph node idzo dzine radioactive chinhu kana kutsvaga lymph node dzakasvibiswa nedhayi yebhuruu. Kana sentinel lymph node yavapo, chiremba anovhiya anoita incision diki (inenge 1/2 inch) muganda rakapfurikidza uye inobvisa iyo node.

Iyo sentinel node inozotariswa kuvepo kwekenza maseru nachiremba. Kana kenza ikawanikwa, chiremba anovhiya anogona kubvisa mamwe maLymph node, kungave panguva imwechete yebiopsy maitiro kana panguva yekutevera yekuvhiya nzira. SLNB inogona kuitwa pasipatient kana kuti ingangoda kugara kwenguva pfupi muchipatara.

SLNB inowanzoitwa panguva imwechete iyo bundu rekutanga rinobviswa. Mune zvimwe zviitiko maitiro acho anogona zvakare kuitwa pamberi kana kunyangwe mushure (zvichienderana nekuti midziyo yeLymphatic yakavhiringidzwa sei) kubvisa bundu.

Ndezvipi zvakanakira SLNB?

SNLB inobatsira vanachiremba danho rekenza uye nekufungidzira njodzi yekuti tumarara maseru akagadzira kugona kupararira kune dzimwe nhengo dzemuviri. Kana iyo sentinel node isina kunaka nekenza, murwere anogona kukwanisa kudzivirira kuwanda kwema lymph node kuvhiyiwa, kudzikisira izvo zvingangoita zvinetso zvine chekuita nekubviswa kwema lymph node mazhinji.

Ndezvipi zvinogona kukuvadza zveSNNB?

Kuvhiya kwese kubvisa lymph node, kusanganisira SLNB, kunogona kukuvadza mhedzisiro, kunyangwe kubviswa kwema lymph node mashoma kunowanzo kuve kwakabatana nemhedzisiro mhedzisiro, kunyanya zvakakomba senge lymphedema. Izvo zvinogona kuitika mhedzisiro zvinosanganisira:

• Lymphedema, kana kuzvimba kwetishu. Munguva yekuvhiya lymph node, lymph lymph inotungamira kuenda uye kubva kune sentinel node kana boka renzvimbo dzinochekwa Izvi zvinokanganisa kuyerera kwese kwemajumusi kuburikidza nenzvimbo yakakanganiswa, izvo zvinogona kutungamira kune isina kujairika kuvaka ye lymph fluid inogona kukonzera kuzvimba. Lymphedema inogona kukonzeresa kurwadziwa kana kusagadzikana munzvimbo yakakanganiswa, uye iro ganda rinopfurikidza rinogona kuwedzera kana kuoma.

Ngozi ye lymphedema inowedzera pamwe nenhamba yema lymph node abviswa. Kune njodzi shoma nekubviswa kweiyo chete sentinel lymph node. Muchiitiko chekuwedzera lymph node kubviswa muhapwa kana kugomera, iko kuzvimba kunogona kukanganisa ruoko rwese kana gumbo. Uye zvakare, kune mukana wekuwedzera wehutachiona munzvimbo yakakanganiswa kana mitezo. Kashoma kwazvo, chisingaperi lymphedema nekuda kwekuwedzera lymph node kubviswa kunogona kukonzera kenza yemidziyo yeLymphatic inonzi lymphangiosarcoma.

• Seroma, kana hombe kana bundu rinokonzerwa nekuvakwa kweiyo lymph fluid panzvimbo yekuvhiyiwa

• Chiveve, kurira, kuzvimba, kupwanya, kana kurwadziwa panzvimbo yekuvhiyiwa, uye njodzi yekuwedzera hutachiona

• Zvakaoma kufambisa chikamu chakakanganiswa chemuviri

• Ganda kana allergic reaction kune iyo bhuruu dhayi inoshandiswa muSNLB

• Mhedzisiro-yakaipa biopsy mhedzisiro - kureva kuti, maseru emukenza haaonekwe mune sentinel lymph node kunyangwe hazvo yakatopararira kumatunhu enode node kana zvimwe zvikamu zvemuviri. Mhedzisiro-yakaipa biopsy mhedzisiro inopa murwere uye chiremba pfungwa yenhema yekuchengetedzeka nezve huwandu hwekenza mumuviri wemurwere.

Is SLNB inoshandiswa kubatsira kuisa mhando dzese dzekenza?

Kwete. SLNB inowanzo shandiswa kubatsira padanho gomarara repazamu uye melanoma. Iyo dzimwe nguva inoshandiswa kuisa cancer yepenile (1) uye endometrial cancer (2). Nekudaro, iri kuongororwa nedzimwe mhando dzekenza, kusanganisira vulvar uye kenza yemuromo wechibereko (3), uye colorectal, gastric, esophageal, musoro nemutsipa, thyroid, uye isiri-diki maseru kenza mapapu (4).

Chii chakaratidza kutsvagiswa nezvekushandiswa kweSLNB mukenza yemazamu?

Maseru emukaka wepazamu anonyanya kupararira kutanga kune ma "lymph node" ari mune axilla, kana nzvimbo yehapwa, padyo nezamu rakabatwa. Zvisinei, mukenza yemazamu iri padyo nepakati pechipfuva (padhuze nepfupa rechipfuva), maseru emukenza anogona kutanga kupararira kuma lymph node mukati mechipfuva (pasi pechipfuva, chinonzi mukati mammary node) vasati vaonekwa muaxilla.

Huwandu hwema lymph node muaxilla hunosiyana kubva pamunhu kusvika pamunhu; yakajairwa renji iri pakati pe20 ne40. Nhoroondo, ese aya axillary lymph node akabviswa (mukuvhiya kunonzi axillary lymph node dissection, kana ALND) mune vakadzi vanoonekwa vaine kenza yemazamu. Izvi zvakaitwa nekuda kwezvikonzero zviviri: kubatsira kubatira gomarara repazamu uye kubatsira kudzivirira kudzokorodza kwechirwere mudunhu. (Kudzokororwa kwenharaunda kwekenza yemazamu kunoitika kana maseru emukenza emuzamu ayo akatamira kune ma lymph node ari padyo anomutsa bundu idzva.)

Sentinel lymph node biopsy yezamu. Chinhu chine radioactive uye / kana dhayi yebhuruu inoraswa padhuze nebundu (pekutanga jira). Iyo jekiseni zvinhu inowanikwa zvinoonekwa uye / kana nechishandiso chinoona radioactivity (yepakati pani). Iyo sentinel node (s) (iyo yekutanga lymph node (s) kutora izvo zvinhu) ndeye (akabviswa) uye akaongororwa cancer maseru (ekupedzisira mapaneru).

Nekudaro, nekuti kubvisa akawanda ma lymph node panguva imwechete kunowedzera njodzi yemhedzisiro inokuvadza, kiriniki miedzo yakatangwa kuti iongorore kuti ingangove here iyo sentinel lymph node inogona kubviswa. Zvikamu zviviri zveNCI-zvakatsigirwa zvakasarudzika chikamu chechitatu chemakiriniki miedzo yakaratidza kuti SLNB isina ALND inokwana kuisa kenza yemazamu uye yekudzivirira kudzoka kwematunhu kune vakadzi vasina zviratidzo zvekuchipatara zveaxillary lymph node metastasis, senge bundu kana kuzvimba muhapwa izvo zvinogona kukonzera kusagadzikana, uye ndiani anorapwa nekuvhiyiwa, adjuvant systemic therapy, uye radiation radiation.

Mune kumwe kuyedza, kwaisanganisira vakadzi ve5,611, vaongorori vakasarudzika vatori vechikamu kuti vagamuchire chete SLNB, kana SLNB pamwe neALND, mushure mekuvhiyiwa (5). Vakadzi ivavo vari mumapoka maviri ane sentinel lymph node (s) vaive negomarara (huwandu hwevakadzi 3,989) vakabva vateverwa kweavhareji yemakore masere. Vatsvaguriri havana kuwana mutsauko muhupenyu hwese kana kurarama-husina chirwere pakati pemapoka maviri evakadzi.

Kumwe kuyedza kwaisanganisira vakadzi mazana masere nepfumbamwe nemapundu anosvika masendimita mashanu muzamu uye imwechete kana maviri akanaka sentinel lymph node. Varwere vaiwanzopihwa kuti vagamuchire SLNB chete kana kuti vagamuchire ALND mushure meSLNB (6). Vese vakadzi vacho vakarapwa ne lumpectomy, uye vazhinji vakagashirawo adjuvant systemic Therap uye yekunze-danda radiation radiation kuzamu rakabatwa. Mushure mekuwedzeredzwa kwekutevera, iwo mapoka maviri evakadzi aive akafanana 10-gore rese kupona, kupona-kusununguka kwezvirwere, uye kumatunhu ekudzokorodza (7).

Chii chakaratidza kutsvagiswa nezvekushandiswa kweSLNB mu melanoma?

Kutsvagurudza kunoratidza kuti varwere vane melanoma vakapinda muSNNB uye vane sentinel lymph node inoonekwa isina kunaka negomarara uye vasina zviratidzo zvekuchipatara kuti kenza yapararira kune mamwe ma "lymph node" anogona kuponeswa nekuvhiyiwa kwakawanda kwemazamu panguva yethumba rekutanga. kubvisa. Meta-ongororo yezvidzidzo makumi manomwe neshanu zvine data kubva kuvarwere makumi maviri nemakumi maviri nemakumi mana vakaona kuti njodzi yeruoko node yekudzokororazve kune varwere vane yakaipa SLNB yaive 5% kana zvishoma (8).

Sentinel lymph node biopsy mune murwere ane melanoma. Chinhu chine radioactive uye / kana dhayi yebhuruu inoraswa padhuze nebundu (pekutanga jira). Iyo jekiseni zvinhu inowanikwa zvinoonekwa uye / kana nechishandiso chinoona radioactivity (yepakati pani). Iyo sentinel node (s) (iyo yekutanga lymph node (s) kutora izvo zvinhu) ndeye (akabviswa) uye akaongororwa cancer maseru (ekupedzisira mapaneru). Sentinel lymph node biopsy inogona kuitwa pamberi kana mushure mekunge bundu rabviswa.

Zviwanikwa kubva kuMulticenter Selective Lymphadenectomy Trial II (MSLT-II) zvakare yakasimbisa kuchengetedzwa kweSLNB kune vanhu vane melanoma ine yakanaka sentinel lymph node uye pasina humbowo hwekiriniki hweimwe lymph node kubatanidzwa. Ichi chikamu chakakura chechikamu chechitatu chemakiriniki ekuyedzwa, icho chaisanganisira varwere vanopfuura chiuru nemazana mapfumbamwe, ichienzanisa mukana wekurapa weSNNB pamwe nekubviswa nekukurumidza kwenzvimbo dzasara dzenzvimbo dzemakondomu (dzinodaidzwa kunzi kupedzisa lymph node dissection, kana CLND) ine SNLB pamwe nekutarisa kunoshanda, uko kwaisanganisira kugara uchiongorora Ultrasound kuongororwa kweakasara enharaunda lymph node uye kurapwa neCLND kana zviratidzo zvekuwedzera lymph node metastasis yakaonekwa.

Mushure mekuteedzana kwepakati pemwedzi makumi mana nemana, varwere vaive vawana CLND nekukasira havana kurarama zviri nani melanoma pane avo vaive vawana SLNB neCLND chete kana zviratidzo zvekuwedzera kwema lymph node metastasis zvikaonekwa (86% yevatori vechikamu mumapoka ese maviri haana kufa nemelanoma makore matatu) (9).

Sarudzo Referensi

1. Mehralivand S, van der Poel H, Nguva yechando A, et al. Sentinel lymph node imaging mune urologic oncology. Dudziro Andrology uye Urology 2018; 7 (5): 887-902. [PubMed Abstract]
2. Renz M, Diver E, Chirungu D, et al. Sentinel lymph node biopsies mune endometrial cancer: Dzidzira maitiro pakati pegynecologic oncologists muUnited States. Chinyorwa cheMinimally Invasive Gynecology 2019 Kubvumbi 10. pii: S1553-4650 (19) 30184-0. [PubMed Abstract]
3. Reneé Franklin C, Tanner EJ III. Tiri kuenda kupi nesentinel lymph node mapping mune gynecologic cancer? Ikozvino Oncology Mishumo 2018; 20 (12): 96. [PubMed Abstract]
4. Chen SL, Iddings DM, Scheri RP, Bilchik AJ. Mepu yeLymphatic uye sentinel node kuongorora: zvazvino pfungwa uye mashandisiro CA: A Cancer Chinyorwa cheMakiriniki 2006; 56 (5): 292-309. [PubMed Abstract]
5. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection kana ichienzaniswa neakajairwa axillary-lymph-node dissection muzvipatara zvisina tsarukano varwere vane kenza yemazamu: zviwanikwa zvekupona kubva ku NSABP B-32 kusarongeka chikamu chechitatu kutongwa. Lancet Oncology 2010; 11 (10): 927–933. [PubMed Abstract]
6. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA: The Journal of the American Medical Association 2011; 305(6):569–575. [PubMed Abstract]
7. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 2017; 318(10):918-926. [PubMed Abstract]
8. Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. Journal of Clinical Oncology 2011; 29(11):1479–1487. [PubMed Abstract]
9. Faries MB, Thompson JF, Cochran AJ, et al. Kugadzirisa dissection kana kucherechedza sentinel-node metastasis mu melanoma. New England Chinyorwa cheMishonga 2017; 376 (23): 2211-2222. [PubMed Abstract]