БИОПСИЯ СТОРОЖЕВЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ В ПРОФИЛАКТИКЕ РЕГИОНАРНЫХ РЕЦИДИВОВ У БОЛЬНЫХ С ЛОКАЛИЗОВАННОЙ МЕЛАНОМОЙ КОЖИ

Objective. To determine  an optimal  method  for preventing regional relapses in patients with locally advanced cutaneous melanoma (CM). Material and methods. The investigation included 755 patients  with locally advanced  CM who had been treated  at the Medical Radiology  Research  Centre.  Among them, 213 patients had wide excision only for the primary tumor; 242 patients  were additionally  treated  with preventive  lymphadenectomy (pLAE), and 300 patients  underwent  sentinel  lymph node (SLN) biopsy. The groups were matched for the local extent  of a tumor in the TNM  staging  (p = 0.178), which  allowed  a proper comparative analysis  of treatment  results.  The Russian  radiopharmaceutical 99mTc-Technefit  having  necessary lymphotropic  properties  was used  to identify  SLN.  Intraoperative  navigation  was  performed using a Radical handheld gamma probe counter (Amplitude Research  and Technology Center, Russia). Results. Regional relapses were observed in 20.2% of cases in the primary CM excision group. In the pLAE group, latent regional lymph node metastases were detected in 10.7% of the patients; and 12.0% more of the patients  developed subsequently regional relapses  in the  intact  lymph nodes.  The total  number of latent regional  metastases in this  group was  22.7%; these  were  diagnosed  as a result of pLAE in less than half of the cases  (47.3%). SLN biopsy revealed  subclinical regional metastases in 20.7% of the  patients   and  regional  relapses   were  seen   only  in  3.3%. Overall, SLN biopsy could detect latent lymph node metastases in 86.1% of all cases; these were demonstrated  with clinical relapses  only in 13.9%. The efficiency  of SLN biopsy in preventing regional relapses   was  significantly   higher  than  was  achievable   during pLAE (p =0.001). The five  and seven-year survival  rates  were 61.5 ± 4.3 and 54.3 ± 4.6% in the CM excision group, respectively; 68.8 ± 0.35 and 61.3±3.9%  in the pLAE group; and 84.8 ± 6.5 and 84.8 ± 6.5% in the SLN biopsy group (p = 0.001). Conclusion. The investigation of SLN is the most  effective, safe,  and reproducible  technique  for the early detection of subclinical  regional  metastases and for the  prevention  of  regional relapses  in patients  with locally advanced  CM. Reliable  regional control  in turn makes it possible  to hope for the best  long-term treatment results.