Malunga-nomhlaza / isifo-sokulinganisa / sokulinganisa / sentinel-node-biopsy-inyani-sheet

I-Sentinel Lymph yeNode Biopsy

Yintoni ii-lymph node?

Iimpawu zeLymph zizitho ezincinci ezijikelezayo eziyinxalenye yenkqubo ye-lymphatic body. Inkqubo ye-lymphatic yinxalenye ye-immune system. Inomsebenzi wothungelwano lweenqanawa kunye namalungu ane-lymph, ulwelo olucacileyo oluthwala usulelo olwa neeseli ezimhlophe zegazi kunye nolwelo kunye nemveliso yenkunkuma evela kwiiseli zomzimba kunye nezicubu zomzimba. Kumntu onomhlaza, i-lymph nayo inokuthwala iiseli zomhlaza eziye zaqhekeka kwi-tumor ephambili.

I-Anatomy yenkqubo ye-lymphatic, ebonisa iinqanawa ze-lymph kunye nezitho ze-lymph, kubandakanywa i-lymph nodes, i-tonsils, i-thymus, i-spleen kunye nomongo wethambo. I-inset ephezulu ibonisa ukwakheka kwe-lymph node kunye nemithambo ye-lymph, kunye neentolo ezibonisa indlela i-lymph kunye neeseli zomzimba ezibizwa ngokuba zii-lymphocyte zingena ziphuma kwi-lymph node. I-inset engezantsi ibonisa ukuvalwa komongo wethambo.

I-Lymph ihluzwa nge-lymph nodes, ezifumaneka ngokubanzi kuwo wonke umzimba kwaye zixhunyaniswe omnye nomnye ngeempahla ze-lymph. Amaqela e-lymph node abekwe entanyeni, ngaphantsi kweengalo, esifubeni, esiswini kunye nasemiphakathini. Ii-lymph node ziqukethe iiseli ezimhlophe zegazi (iiL lymphocyte kunye neeL lymphocyte) kunye nezinye iintlobo zeeseli zomzimba. Iimpawu zeLymph zibambe iintsholongwane kunye neentsholongwane, kunye nezinye iiseli ezonakalisiweyo nezingaqhelekanga, ukunceda amajoni omzimba alwe nezifo.

Iindidi ezininzi zomhlaza zisasazeka ngenkqubo ye-lymphatic, kwaye enye yezona ndawo zokuqala zokusasazeka kwezi mhlaza zii-lymph node ezikufutshane.

Yintoni i-sentinel lymph node?

I-lymph node ye-sentinel ichazwa njenge-lymph node yokuqala apho iiseli zomhlaza zinokuthi zisasazeka kwi-tumor yokuqala. Ngamanye amaxesha, kunokubakho ngaphezulu kwesinye sentinel lymph node.

Yintoni i-sentinel lymph node biopsy?

I-sentinel lymph node biopsy (SLNB) yinkqubo apho i-sentinel lymph node ichongiwe, isuswe, kwaye ihlolwe ukufumanisa ukuba ingaba iiseli zomhlaza zikhona na. Isetyenziswe kubantu abaye bafumanisa ukuba banomdlavuza.

Iziphumo ezimbi ze-SLNB zibonisa ukuba umhlaza awukasasazeki kwii-lymph node ezikufuphi okanye kwamanye amalungu.

Iziphumo ezincomekayo ze-SLNB zibonisa ukuba umhlaza ukhona kwi-lymph node ye-sentinel kwaye inokuthi isasazeke nakwezinye iindawo ezikufutshane (ezibizwa ngokuba zii-lymph node zengingqi) kwaye, ngamanye amalungu. Olu lwazi lunokunceda ugqirha amisele inqanaba lomhlaza (ubungakanani besifo emzimbeni) kunye nokuphuhlisa isicwangciso sonyango esifanelekileyo.

Kwenzeka ntoni ngexesha le-SLNB?

Okokuqala, kufuneka kubekwe i-sentinel lymph node (okanye iindawo). Ukwenza njalo, ugqirha utofa into enemitha yeathom, idayi eblue, okanye zombini kufutshane nethumba. Ugqirha ke usebenzisa isixhobo ukufumana ii-lymph node eziqulathe into enemitha ye-radioactive okanye ujonge ii-lymph node ezinedayi eluhlaza. Nje ukuba i-lymph node ye-sentinel ifumaneke, ugqirha wotyando wenza usiko oluncinci (malunga ne-intshi ye-1/2) kulusu olugqithisileyo kwaye asuse i-node.

I-node ye-sentinel iyakhangelwa ubukho beeseli zomhlaza ngugqirha wezifo. Ukuba umhlaza ufunyenwe, ugqirha wotyando angasusa ii-lymph node ezongezelelweyo, nokuba kukwinkqubo efanayo ye-biopsy okanye ngexesha lotyando olulandelayo. I-SLNB inokwenziwa ngaphandle okanye ingafuna ukuhlala ixesha elifutshane esibhedlele.

I-SLNB ihlala isenziwa ngaxeshanye kususwe ithumba lokuqala. Ngamanye amaxesha le nkqubo inokwenziwa ngaphambi okanye nasemva (kuxhomekeke ekubeni zininzi kangakanani iimpahla ze-lymphatic eziphazamisekileyo) ukususwa kwethumba.

Zithini izibonelelo ze-SLNB?

I-SNLB inceda oogqirha kwinqanaba lomhlaza kwaye baqikelele umngcipheko wokuba iiseli zesisu zikhulise amandla okusasazeka kwamanye amalungu omzimba. Ukuba i-node ye-sentinel ayinasifo somhlaza, isigulana sinokukwazi ukunqanda utyando lwe-lymph node, ukunciphisa iingxaki ezinokubakho xa kususwe ii-lymph node.

Zeziphi izinto ezinokubangela ingozi kwi-SLNB?

Lonke utyando lokususa ii-lymph node, kubandakanya i-SLNB, kunokuba neziphumo ebezingalindelekanga eziyingozi, nangona ukususwa kwee-lymph node ezimbalwa kuhlala kunxulunyaniswa neziphumo ebezingalindelekanga ezimbalwa, ngakumbi ezinje nge-lymphedema. Iziphumo ezinokubakho zibandakanya:

• I-Lymphedema, okanye ukudumba kwezicubu. Ngethuba lotyando lwe-lymph node, iinqanawa ze-lymph ezikhokelela kunye nakwi-sentinel node okanye iqela le-node liyanqunyulwa. Oku kuphazamisa ukuhamba okuqhelekileyo kwe-lymph kwindawo echaphazelekayo, enokuthi ikhokelele kulwakhiwo olungaqhelekanga lwe-lymph fluid enokubangela ukudumba. I-Lymphedema inokubangela iintlungu okanye ukungonwabi kwindawo echaphazelekayo, kwaye ulusu olugqithisileyo lunokuba lukhuni okanye lube nzima.

Umngcipheko we-lymphedema uyanda ngenani le-lymph node ezisusiweyo. Kukho umngcipheko omncinci ngokususwa kwe-lymph node kuphela. Kwimeko yokususwa kwe-lymph node ebanzi ekhwapheni okanye kumphimbo, ukudumba kunokuchaphazela ingalo yonke okanye umlenze. Ukongeza, kukho umngcipheko okhulayo wosulelo kwindawo echaphazelekayo okanye kwilungu lomzimba. Kunqabile kakhulu, i-lymphedema engapheliyo ngenxa yokususwa kwe-lymph node enkulu kunokubangela umhlaza kwimithambo ye-lymphatic ebizwa ngokuba yi-lymphangiosarcoma.

• I-Seroma, okanye ubunzima okanye iqhuma elibangelwa kukwakhiwa kwe-lymph fluid kwindawo yotyando

• Ubudenge, ukurhawuzelela, ukudumba, ukutyumza, okanye iintlungu kwindawo yotyando, kunye nomngcipheko owandayo wosulelo

• Kunzima ukuhambisa icandelo lomzimba elichaphazelekayo

• Ulusu okanye uluvo kwibala eblue esetyenziswe kwi-SNLB

• Isiphumo se-biopsy esingeyonyani-oko kukuthi, iiseli zomhlaza azibonwa kwi-sentinel lymph node nangona sele zisasazekile kwiindawo ze-lymph node okanye amanye amalungu omzimba. Iziphumo ezingalunganga ze-biopsy zinika isigulana kunye nogqirha umbono ongeyonyani wokhuseleko malunga nobungakanani besifo somhlaza emzimbeni wesigulana.

Ngaba i-SLNB isetyenziselwa ukunceda zonke iintlobo zomhlaza?

Hayi. I-SLNB ixhaphake kakhulu ukunceda kwinqanaba lomhlaza webele kunye ne-melanoma. Ngamanye amaxesha isetyenziselwa ukwenza umhlaza wepenile (1) kunye nomhlaza we-endometrium (2). Nangona kunjalo, kuyafundwa nezinye iintlobo zomhlaza, kubandakanya i-vulvar kunye nomhlaza womlomo wesibeleko (3), kunye ne-colorectal, gastric, esophageal, intloko nentamo, i-thyroid, kunye nomhlaza womhlaza wesifo somhlaza (4).

Yintoni eboniswe luphando malunga nokusetyenziswa kweSLNB kumhlaza wamabele?

Iiseli zomhlaza wamabele kunokwenzeka ukuba zisasazeke kuqala kwii-lymph node ezikwi-axilla, okanye indawo ye-armpit, ecaleni kwebele elichaphazelekayo. Nangona kunjalo, kumhlaza webele osondele kwiziko lesifuba (kufutshane nesifuba sesifuba), iiseli zomhlaza zinokusasazeka kuqala kwii-lymph node ngaphakathi kwesifuba (phantsi kwethambo lesifuba, elibizwa ngokuba zii-mammary node) ngaphambi kokuba zibonwe kwi-axilla.

Inani le-lymph node kwi-axilla lihluka kumntu kumntu; Uluhlu oluqhelekileyo luphakathi kwama-20 nama-40. Ngokwembali, zonke ezi nkovu ze-axillary zisuswe (kwintsebenzo ebizwa ngokuba yi-axillary lymph node dissection, okanye i-ALND) kwabasetyhini abanesifo somhlaza webele. Oku kwenziwa ngezizathu ezibini: ukunceda kwinqanaba lomhlaza webele kunye nokunceda ukuthintela ukuphindaphinda kwesi sifo kwesi sifo. (Ukuphindaphinda kwengingqi yomhlaza webele kwenzeka xa iiseli zomhlaza webele ezifudukele kwii-lymph node ezikufutshane zivelisa ithumba elitsha.)

I-Sentinel lymph node biopsy yebele. Into ene-radioactive kunye / okanye idayi eblowu ifakwe kwisitofu kufutshane nethumba (iphaneli yokuqala). Izinto ezifakiweyo zibekwe ngokubonakalayo kunye / okanye ngesixhobo esifumanisa ukusebenza kwe-radioactivity (iphaneli esembindini). I (s) node (s) (ii-lymph node zokuqala ukuthatha izinto) (ziyasuswa kwaye zijongwe iiseli zomhlaza (iphaneli yokugqibela).

Nangona kunjalo, ngenxa yokususa ii-lymph node ezininzi ngaxeshanye kwandisa umngcipheko weziphumo ebezingalindelekanga eziyingozi, kwaqaliswa ulingo lweklinikhi ukuphanda ukuba ngaba ii-lymph node ze-sentinel zinokususwa na. Izilingo ezimbini zeklinikhi ezixhaswe yi-NCI ezixhaswe ngononophelo zibonise ukuba i-SLNB ngaphandle kwe-ALND yanele ukubeka umhlaza webele kunye nokuthintela ukuphindaphinda kwengingqi kwabasetyhini abangenazo iimpawu zeklinikhi ye-axillary lymph node metastasis, enjengeqhuma okanye ukudumba ekhwapheni okunokuthi kubangela ukungonwabi, kwaye ngubani onyangwa ngoqhaqho, unyango oluncedisayo lwenkqubo, kunye nonyango lwemitha.

Kwilingo elinye, elibandakanya abafazi abangama-5,611, abaphandi babela abathathi-nxaxheba ukuba bafumane nje i-SLNB, okanye i-SLNB kunye ne-ALND, emva kotyando (5). Abo bafazi kula maqela mabini abathumela i-lymph node (s) yabo babengena-cancer (bebonke ngama-3,989 abasetyhini) balandelwa ngokomyinge weminyaka esi-8. Abaphandi abafumani mahluko kubomi obupheleleyo okanye ekungabikho kwezifo phakathi kwala maqela mabini abasetyhini.

Elinye ityala lalibandakanya abasetyhini abangama-891 abanezilonda ukuya kuthi ga kwi-5 cm esifubeni kunye nenye okanye ezimbini ezithembekileyo ze-sentinel lymph node. Izigulana zabelwa ngokulandelelana ukuba zifumane i-SLNB kuphela okanye zifumane i-ALND emva kweSLNB (6). Bonke abantu basetyhini baphathwa nge-lumpectomy, kwaye uninzi lwafumana unyango lwe-adjuvant systemic kunye nonyango lwe-radiation lwangaphandle kwimitha echaphazelekayo. Emva kokulandelwa okwandisiweyo, la maqela mabini abasetyhini aneminyaka efanayo ye-10 yeminyaka yokuphila, ukungabikho kwezifo, kunye namanqanaba okuphindaphinda kwengingqi (7).

Yintoni ebonakalise uphando malunga nokusetyenziswa kwe-SLNB kwi-melanoma?

Uphando lubonisa ukuba abaguli abanesifo se-melanoma abaye bafumana i-SLNB kwaye i-sentinel lymph node ifunyenwe ingenasifo somhlaza kwaye abangenazo iimpawu zeklinikhi ukuba umhlaza usasazekile kwezinye i-lymph node ungasindiswa kuqhaqho oluninzi lwe-lymph node ngexesha lesifo sokuqala. ukususwa. Uhlalutyo lwe-meta lwezifundo ezingama-71 ezinedatha esuka kwizigulana ezingama-25,240 zafumanisa ukuba umngcipheko we-lymph node yokuphinda ubuye kwizigulana ezine-SLNB engalunganga yayiyi-5% okanye ngaphantsi (8).

I-Sentinel lymph node biopsy kwisigulana esine-melanoma. Into ene-radioactive kunye / okanye idayi eblowu ifakwe kwisitofu kufutshane nethumba (iphaneli yokuqala). Izinto ezifakiweyo zibekwe ngokubonakalayo kunye / okanye ngesixhobo esifumanisa ukusebenza kwe-radioactivity (iphaneli esembindini). I (s) node (s) (ii-lymph node zokuqala ukuthatha izinto) (ziyasuswa kwaye zijongwe iiseli zomhlaza (iphaneli yokugqibela). I-Sentinel lymph node biopsy inokwenziwa ngaphambi okanye emva kokuba isisu sisuswe.

Iziphumo ezifunyenwe kwi-Multicenter Selective Lymphadenectomy Trial II (MSLT-II) ikwaqinisekisile ukhuseleko lwe-SLNB kubantu abane-melanoma abane-sentinel lymph node kwaye abukho ubungqina bezonyango bolunye uhlobo lwe-lymph node. Olu vavanyo olukhulu lwezonyango lwe-3, olubandakanya ngaphezulu kwe-1,900 yezigulana, xa kuthelekiswa isibonelelo sonyango esinokubakho se-SLNB kunye nokususwa kwangoko kwe-lymph node ezisele (ezibizwa ngokuba kukugqitywa kwe-lymph node dissection, okanye i-CLND) nge-SNLB kunye nokujonga okusebenzayo, okubandakanya Ukuhlolwa rhoqo kwe-ultrasound ye-lymph nodes esele yonyango kunye nonyango lwe-CLND ukuba iimpawu zokongezwa kwe-lymph node metastasis ziye zafunyanwa.

Emva kokulandelwa okuphakathi kweenyanga ezingama-43, abaguli ebebekhe bafumana i-CLND kwangoko khange babe nokuphila okungcono kwe-melanoma kunaleyo ifunyenwe yi-SLNB nge-CLND kuphela xa kuvela iimpawu ezongezelelekileyo ze-lymph node metastasis (i-86% yabathathi-nxaxheba kuwo omabini amaqela khange afe ngenxa ye-melanoma kwiminyaka emi-3) (9).

Izalathiso ezikhethiweyo

1. Mehralivand S, van der Poel H, Ubusika A, et al. I-Sentinel lymph node imaging kwi-onologology ye-urologic. I-Andrology yokuguqulela kunye ne-Urology 2018; I-7 (5): 887-902. [PubMed Abstract]
2. URenz M, Diver E, isiNgesi D, et al. I-Sentinel lymph node biopsies kumhlaza we-endometrial: Ziqhelanise neepateni phakathi kwe-gynecologic oncologists eMelika. Ijenali ye-Gynecology encinci yokuhlasela i-2019 Apr 10. pii: S1553-4650 (19) 30184-0. [PubMed Abstract]
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5. UKrag DN, uAnderson SJ, uJulian TB, et al. I-Sentinel-lymph-node resection ngokuthelekiswa nesiqhelo se-axillary-lymph-node dissection kwizigulana ezingena-kliniki ezinesifo somhlaza wamabele: iziphumo zokuphila ngokubanzi kwi-NSABP B-32 yolingo lwesigaba 3. ILancet Oncology 2010; 11 (10): 927–933. [PubMed Abstract]
6. UGiuliano AE, uHunt KK, uBallman KV, et al. Ukusasazeka kwe-Axillary vs no disill axillary kwabasetyhini abanomhlaza webele kunye ne-sentinel node metastasis: ulingo lwezonyango olungenamsebenzi. I-JAMA: Ijenali yoMbutho Wezonyango waseMelika ngo-2011; 305 (6): 569-575. [PubMed Abstract]
7. UGiuliano AE, uBallman KV, uMcCall L, et al. Iziphumo zokuqhekeka kwe-axillary vs no disill axillary on 10-year lokusinda ngokubanzi phakathi kwabasetyhini abanomdlavuza webele kunye ne-sentinel node metastasis: I-ACOSOG Z0011 (Alliance) yolingo lwezonyango olungenamkhethe. IJAMA 2017; 318 (10): 918-926. [PubMed Abstract]
8. UValsecchi ME, uSilbermins D, de Rosa N, Wong SL, noLyman GH. Imephu ye-lymphatic kunye ne-sentinel lymph node biopsy kwizigulana ezine-melanoma: uhlalutyo lweemeta. Ijenali ye-Clinical Oncology 2011; 29 (11): 1479–1487. [PubMed Abstract]
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