Cishe-umdlavuza / ukuxilongwa-ukubeka isiteji / isiteji / i-sentinel-node-biopsy-fact-sheet

ISentinel Lymph Node Biopsy

Yini ama-lymph node?

Ama-lymph node yizitho ezincane eziyindilinga eziyingxenye yohlelo lwe-lymphatic yomzimba. Uhlelo lwe-lymphatic luyingxenye yamasosha omzimba. Iqukethe inethiwekhi yemikhumbi nezitho eziqukethe i-lymph, uketshezi olucacile oluthwala ukutheleleka-ukulwa namaseli amhlophe egazi kanye nemikhiqizo yoketshezi nemfucuza evela kumaseli nezicubu zomzimba. Kumuntu onomdlavuza, i-lymph nayo ingathwala amangqamuzana omdlavuza aqhamukile esihlahleni esikhulu.

I-anatomy yohlelo lwe-lymphatic, ekhombisa imithambo ye-lymph nezitho ze-lymph, kufaka phakathi ama-lymph node, amalaka, i-thymus, ubende nomnkantsha wethambo. I-inset ephezulu ikhombisa ukwakheka kwe-lymph node kanye nemithambo ye-lymph, ngemicibisholo ekhombisa ukuthi amangqamuzana e-lymph namasosha omzimba abizwa ngokuthi ama-lymphocyte angena futhi aphume kanjani ku-lymph node. I-inset engezansi ikhombisa ukuvalwa komnkantsha wethambo.

I-lymph ihlungwa ngama-lymph node, atholakala kabanzi kuwo wonke umzimba futhi axhunywe komunye nomunye ngemikhumbi ye-lymph. Amaqembu ama-lymph node atholakala entanyeni, ngaphansi kwekhwapha, esifubeni, esiswini, nasemgodini. Ama-lymph node aqukethe amangqamuzana amhlophe egazi (ama-lymphocyte B nama-T lymphocyte) nezinye izinhlobo zamaseli omzimba. Ama-lymph node abamba amabhaktheriya namagciwane, kanye namanye amangqamuzana alimele futhi angajwayelekile, asiza amasosha omzimba alwe nezifo.

Izinhlobo eziningi zomdlavuza zisakazeka ngohlelo lwe-lymphatic, kanti enye yezindawo zokuqala zokusakazeka kwale mdlavuza ngama-lymph node aseduze.

Yini i-sentinel lymph node?

I-sentinel lymph node ichazwa njenge-lymph node yokuqala lapho amangqamuzana omdlavuza kungenzeka ukuthi asabalale avela isimila sokuqala. Kwesinye isikhathi, kungaba nezimpawu ezingaphezu kweyodwa ze-sentinel lymph node.

Yini i-sentinel lymph node biopsy?

I-sentinel lymph node biopsy (SLNB) inqubo lapho kutholwa khona i-sentinel lymph node, isuswe, futhi ihlolwe ukuthola ukuthi ngabe amangqamuzana omdlavuza akhona yini. Isetshenziswa kubantu asebethole ukuthi banomdlavuza.

Umphumela omubi we-SLNB uphakamisa ukuthi umdlavuza awukasakazeki kuma-lymph node aseduze noma ezinye izitho.

Umphumela omuhle we-SLNB ukhombisa ukuthi umdlavuza ukhona kwi-sentinel lymph node nokuthi kungenzeka ukuthi usabalalele nakwamanye ama-lymph node aseduze (abizwa ngama-lymph node wesifunda) futhi, mhlawumbe, nezinye izitho. Lolu lwazi lungasiza udokotela ukuthi anqume isigaba somdlavuza (ubukhulu besifo emzimbeni) futhi athuthukise uhlelo lokwelashwa olufanele.

Kwenzekani ngesikhathi se-SLNB?

Okokuqala, kufanele kutholakale i-sentinel lymph node (noma ama-node). Ukuze enze kanjalo, udokotela ohlinzayo ujova into ekhipha imisebe, udayi oluhlaza okwesibhakabhaka, noma kokubili eduze kwesimila. Udokotela ohlinzayo ube esesebenzisa ithuluzi ukuthola ama-lymph node aqukethe into ekhipha imisebe noma abheke ama-lymph node agcwele udayi oluhlaza okwesibhakabhaka. Lapho nje i-sentinel lymph node itholakala, udokotela ohlinzayo wenza imbobo encane (cishe u-1/2 intshi) esikhunjeni esigcwele futhi asuse i-node.

I-sentinel node bese ihlolwe ukuthi kukhona amangqamuzana omdlavuza ngudokotela wezifo. Uma umdlavuza utholakala, udokotela ohlinzayo angasusa ama-lymph node angeziwe, kungaba phakathi kwenqubo efanayo ye-biopsy noma ngesikhathi senqubo yokuhlinzwa elandelayo. I-SLNB ingenziwa ngokugula okungalalisiwe noma ingadinga ukuhlala isikhashana esibhedlela.

I-SLNB ivame ukwenziwa ngasikhathi sinye lapho kususwa isimila sokuqala. Kwezinye izimo inqubo ingenziwa futhi ngaphambi nangemva kwalokho (kuya ngokuthi imithambo ye-lymphatic iphazamiseke kangakanani) ukususwa kwesimila.

Ziyini izinzuzo zeSLNB?

I-SNLB isiza odokotela ukuba babe nomdlavuza futhi balinganise ubungozi bokuthi amangqamuzana e-tumor athuthukise ikhono lokusakazeka kwezinye izingxenye zomzimba. Uma ngabe i-sentinel node inesifo somdlavuza, isiguli singakwazi ukugwema ukuhlinzwa okuningana kwe-lymph node, kunciphise izinkinga ezingaba khona ezihambisana nokususwa kwama-lymph node amaningi.

Yikuphi ukulimala okungenzeka kwe-SLNB?

Konke ukuhlinzwa okususa ama-lymph node, kufaka phakathi i-SLNB, kungaba nemiphumela emibi, yize ukususwa kwama-lymph node ambalwa kuvame ukuhlotshaniswa nemiphumela emibi embalwa, ikakhulukazi ebucayi njenge-lymphedema. Imiphumela emibi engaba khona ibandakanya:

• I-Lymphedema, noma ukuvuvukala kwezicubu. Ngesikhathi sokuhlinzwa kwe-lymph node, kusikwa imikhumbi ye-lymph eholela noma isuka ku-sentinel node noma iqembu lama-node. Lokhu kuphazamisa ukugeleza okujwayelekile kwe-lymph endaweni ethintekile, okungaholela ekwakhiweni okungavamile kwe-lymph fluid okungadala ukuvuvukala. I-Lymphedema ingadala ubuhlungu noma ukungaphatheki kahle endaweni ethintekile, futhi isikhumba esikhuphukayo singaqina noma sibe lukhuni.

Ingozi ye-lymphedema iyanda ngenani lama-lymph node asusiwe. Kunobungozi obuncane ngokususwa kwe-sentinel lymph node kuphela. Endabeni yokususwa kwe-lymph node ebanzi ekhwapheni noma emgodini, ukuvuvukala kungathinta ingalo noma umlenze wonke. Ngaphezu kwalokho, kunengozi eyengeziwe yokutheleleka endaweni ethintekile noma isitho. Kuyaqabukela, i-lymphedema engapheli ngenxa yokususwa kwe-lymph node enkulu kungadala umdlavuza wemikhumbi ye-lymphatic ebizwa nge-lymphangiosarcoma.

• Seroma, noma isisindo noma isigaxa esibangelwa ukwakheka kwe-lymph fluid esizeni sokuhlinzwa

• Ukuba ndikindiki, ukuhayiza, ukuvuvukala, ukulinyazwa, noma ubuhlungu endaweni okuhlinzwa kuyo, kanye nengozi eyengeziwe yokutheleleka

• Kunzima ukuhambisa ingxenye yomzimba ethintekile

• Isikhumba noma ukungezwani komzimba nodayi oluhlaza okwesibhakabhaka osetshenziswe ku-SNLB

• Umphumela we-biopsy okungelona iqiniso-okungukuthi, amangqamuzana omdlavuza awabonwa ku-sentinel lymph node yize esevele asakazekela kuma-lymph node wesifunda noma kwezinye izingxenye zomzimba. Umphumela we-biopsy okungelona iqiniso unikeza isiguli nodokotela umuzwa ongewona wokulondeka mayelana nobukhulu besifo somdlavuza emzimbeni wesiguli.

Ngabe i-SLNB isetshenziselwa ukusiza ukufaka zonke izinhlobo zomdlavuza?

Cha. I-SLNB isetshenziswa kakhulu ukusiza isigaba somdlavuza webele kanye ne-melanoma. Kwesinye isikhathi kusetshenziselwa ukufaka umdlavuza we-penile (1) nomdlavuza we-endometrial (2). Kodwa-ke, kufundwa nezinye izinhlobo zomdlavuza, kufaka phakathi i-vulvar kanye nomdlavuza womlomo wesibeletho (3), kanye ne-colorectal, gastric, esophageal, ikhanda nentamo, i-thyroid, kanye nomdlavuza wamaphaphu weseli ongewona omncane (4).

Yini okuboniswe ngucwaningo ngokusetshenziswa kweSLNB kumdlavuza webele?

Amaseli womdlavuza webele kungenzeka ukuthi asabalale kuqala kuma-lymph node atholakala e-axilla, noma endaweni yekhwapha, eduze kwesifuba esithintekile. Kodwa-ke, kumdlavuza webele osondele enkabeni yesifuba (eduze kwesifuba sesifuba), amangqamuzana omdlavuza angasakazeka kuqala kuma-lymph node ngaphakathi kwesifuba (ngaphansi kwesifuba sesifuba, esibizwa ngokuthi ama-mammary node) ngaphambi kokuba kutholakale ku-axilla.

Inani lama-lymph node ku-axilla liyahlukahluka kuye ngomuntu; uhla olujwayelekile luphakathi kuka-20 no-40. Ngokomlando, wonke la ma-lymph node asuswa (kuhlinzwa okuthiwa yi-axillary lymph node dissection, noma i-ALND) kwabesifazane abatholakala benomdlavuza webele. Lokhu kwenziwa ngezizathu ezimbili: ukusiza ukufaka umdlavuza wamabele nokusiza ukuvimbela ukuphindeka kwesifo esifundeni. (Ukuphindeka kwesifunda komdlavuza webele kwenzeka lapho amangqamuzana omdlavuza webele afudukele kuma-lymph node aseduze enza isimila esisha.)

I-Sentinel lymph node biopsy yesifuba. Kufakwa umuthi okhipha imisebe kanye / noma umbala oluhlaza okwesibhakabhaka eduze kwesimila (iphaneli yokuqala). Izinto ezijojwe zitholakala ngokubukeka futhi / noma ngedivayisi ethola ukusebenza kwe-radioactivity (iphaneli eliphakathi). Ama-node (s) ama-sentinel (ama-lymph node (ama) okuqala okuzothatha okokusebenza) (ayasuswa) ahlolwe amaseli womdlavuza (iphaneli yokugcina).

Kodwa-ke, ngoba ukukhipha ama-lymph node amaningi ngasikhathi sinye kwandisa ingozi yemiphumela emibi, kwaqaliswa ukuhlolwa kwemitholampilo ukuphenya ukuthi ngabe ama-lymph node angama-sentinel angasuswa yini. Izilingo ezimbili zomtholampilo ezixhaswe yi-NCI ezixhaswe ngokungahleliwe zikhombisile ukuthi i-SLNB ngaphandle kwe-ALND yanele ukubeka umdlavuza webele nokuvimbela ukuphindeka kwesifunda kwabesifazane abangenazo izimpawu zomtholampilo ze-axillary lymph node metastasis, njengesigaxa noma ukuvuvukala ekhwapheni okungenzeka kubangele ukungakhululeki, futhi ngubani owelashwa ngokuhlinzwa, i-adjuvant systemic therapy, kanye ne-radiation therapy.

Kokunye ukuhlolwa, okubandakanya abesifazane abangu-5 611, abacwaningi babela abahlanganyeli ngezikhathi ezithile ukuthola i-SLNB, noma i-SLNB kanye ne-ALND, ngemuva kokuhlinzwa (5). Labo besifazane kula maqembu amabili abathumeli babo abangama-lymph node babengenalo umdlavuza (abesifazane abangama-3,989 sebebonke) balandelwa ngokwesilinganiso seminyaka eyi-8. Abaphenyi abatholanga mehluko ekusindeni jikelele noma ekusindeni ngaphandle kwezifo phakathi kwamaqembu amabili abesifazane.

Elinye icala lalihlanganisa abesifazane abangama-891 abanezicubu ezifika ku-5 cm esifubeni kanye nelinye noma amabili ama-sentinel lymph node. Iziguli zabelwa ngezikhathi ezithile ukuthola i-SLNB kuphela noma ukuthola i-ALND ngemuva kwe-SLNB (6). Bonke abesifazane baphathwa nge-lumpectomy, futhi iningi labo lathola ukwelashwa kwe-adjuvant systemic kanye nokwelashwa ngemisebe kwangaphandle kwemisebe ebeleni elithintekile. Ngemuva kokulandelwa okunwetshiwe, la maqembu womabili abesifazane asinda iminyaka efanayo eyi-10, ukusinda okungenazifo, kanye namazinga wokuphindeka kwesifunda (7).

Yini ekhonjiswe ucwaningo ngokusetshenziswa kweSLNB kwi-melanoma?

Ucwaningo lukhombisa ukuthi iziguli ezine-melanoma ezithole i-SLNB futhi i-sentinel lymph node etholakala ukuthi ayinayo umdlavuza futhi engenazo izimpawu zomtholampilo zokuthi umdlavuza usabalalele kwamanye ama-lymph node kungasinda ekuhlinzweni okukhulu kakhulu kwe-lymph node ngesikhathi sesimila sokuqala ukususwa. Ukuhlaziywa kwe-meta kwezifundo ezingama-71 ezinemininingwane evela ezigulini ezingama-25,240 kutholakale ukuthi ubungozi bokuphindaphinda kwe-lymph node yesifunda ezigulini ezine-SLNB engemihle kwaba ngu-5% noma ngaphansi (8).

I-Sentinel lymph node biopsy esigulini esine-melanoma. Kufakwa umuthi okhipha imisebe kanye / noma umbala oluhlaza okwesibhakabhaka eduze kwesimila (iphaneli yokuqala). Izinto ezijojwe zitholakala ngokubukeka futhi / noma ngedivayisi ethola ukusebenza kwe-radioactivity (iphaneli eliphakathi). Ama-node (s) ama-sentinel (ama-lymph node (ama) okuqala okuzothatha okokusebenza) (ayasuswa) ahlolwe amaseli womdlavuza (iphaneli yokugcina). I-Sentinel lymph node biopsy ingenziwa ngaphambi noma ngemuva kokususwa kwesimila.

Okutholakele kuMulticenter Selective Lymphadenectomy Trial II (MSLT-II) nakho kuqinisekisile ukuphepha kwe-SLNB kubantu abane-melanoma abane-sentinel lymph node enhle futhi abukho ubufakazi bomtholampilo bokubandakanyeka kwe-lymph node. Lesi silingo esikhulu somtholampilo sesigaba sesi-3 esingahleliwe, esasihlanganisa iziguli ezingaphezu kwe-1,900, siqhathanisa inzuzo engaba khona yokwelashwa ye-SLNB kanye nokususwa ngokushesha kwama-lymph node asele esifunda (abizwa ngokuthi ukuqeda i-lymph node dissection, noma i-CLND) nge-SNLB kanye nokubhekwa okusebenzayo, okubandakanya Ukuhlolwa okuvamile kwe-ultrasound kwama-lymph node wesifunda asele kanye nokwelashwa nge-CLND uma kutholakala izimpawu zokwengeza kwe-lymph node metastasis.

Ngemuva kokulandelwa okuphakathi kwezinyanga ezingama-43, iziguli ezazithole i-CLND ngokushesha azizange zisinde kangcono i-melanoma kunalezo ezazithole i-SLNB nge-CLND kuphela uma kuvela izimpawu ze-lymph node metastasis eyengeziwe (i-86% yabahlanganyeli kuwo womabili la maqembu akazange abulawe yi-melanoma eminyakeni emithathu) (9).

Izinkomba ezikhethiwe

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7. UGiuliano AE, uBallman KV, uMcCall L, et al. Umphumela wokuhlukaniswa kwe-axillary vs no disill axillary ekusindeni kweminyaka eyi-10 phakathi kwabesifazane abanomdlavuza webele ongenayo kanye ne-sentinel node metastasis: I-ACOSOG Z0011 (Alliance) isilingo somtholampilo esingahleliwe. JAMA 2017; 318 (10): 918-926. [I-PubMed Abstract]
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