Zusammenfassung
Das Prinzip des Wächterlymphknotens, der als erste Filterstation eines soliden Tumors entscheidende prognostische Bedeutung besitzt, wird bei Patienten mit malignem Melanom und Mammakarzinom schon heute erfolgreich an großen Patientenzahlen eingesetzt. Ziel ist es, bei nachgewiesener Tumorfreiheit dieses so genannten Sentinel Lymph Node (SLN) auf eine weitere Lymphknotenentfernung zu verzichten und damit die postoperative Morbidität dieses häufig großen Eingriffs zu reduzieren. In ersten klinischen Studien wurde das SLN-Prinzip auch bei Patienten mit Kopf-Hals-Tumoren angewandt, wobei die anatomische Lage des Primärtumors und der am Hals sehr dichte, teilweise bilaterale Lymphabfluss oftmals hohe methodische Probleme aufwerfen können. Neben der geschulten Handhabung der intraoperativen Gammasonde sind insbesondere das genaue präoperative Staging zur Festlegung des N0-Status und die gewissenhafte histopathologische Aufarbeitung des oder der betreffenden Lymphknoten von enormer Bedeutung für die Sensitivität der Methode. Die vorliegende Arbeit fasst die bisher publizierten Daten zur SLN-Methode bei Patienten mit Kopf-Hals-Tumoren zusammen, beschreibt spezielle methodische Aspekte der SLN-Markierung und Szintigraphie und bewertet die gegenwärtige Bedeutung des Verfahrens in der klinischen Routinediagnostik.
Abstract
The concept of the so-called sentinel lymph node (SLN), being the first node draining a malignant tumor and thus carrying the highest risk of metastatic disease, is already frequently applied in patients suffering from malignant melanoma and breast cancer. It is the aim of this concept, to reduce postoperative morbidity by omitting a conventional lymph node dissection if the SLN is proven to be free of any tumor cells. First clinical studies showed promising results also in patients with head and neck cancer. However, both the anatomical localization of the primary tumor and the very complex lymphatic, frequently bilateral drainage pattern may lead to significant methodological problems. Besides a skilful intraoperative usage of the gamma probe, the precise preoperative staging of the respective patient for determination of the N0 status and the assiduous histopathological analysis of the excised SLN are extremely important to reach a maximum of sensitity in this clinical setting. This paper summarizes the data published on the SLN concept in patients with head and neck cancer, describes the several methodological aspects of labeling the SLN with radiocolloides and reviews the today's impact of the SLN method in clinical routine.
Schlüsselwörter
Kopf-Hals-Tumoren - Sentinel Lymph Node - Neck dissection - Gammasonde
Key words
head and neck cancer - sentinel lymph node - neck dissection - gamma probe
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Priv.-Doz. Dr. med. Dipl. Biol. W. U. Kampen
Klinik für Nuklearmedizin · Universitätsklinikum Schleswig-Holstein · Campus Kiel
Arnold-Heller-Str. 9
24106 Kiel
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Email: ukampen@nuc-med.uni-kiel.de
