Abstract
Background: Sentinel node (SN) biopsy can be used to select patients with melanoma for therapeutic lymphadenectomy. We investigated the value of two methods to locate the SN: patent blue dye (PBD) and gamma probe detection of99mTc-nanocolloid.
Methods: One hundred ten patients with cutaneous melanoma were studied. Lymphoscintigraphy with99mTc-nanocolloid was performed to determine the position of the SN. Before operation, PBD was injected at the same site as the radiopharmaceutical. When a blue node was identified intraoperatively, its radioactivity level was measured with the probe. In the absence of blue coloration, the probe was used to trace the SN.
Results: Scintigrams visualized a total of 219 SNs in 141 basins. Eight SNs were not explored. One SN was not found. The remaining 210 and 27 additional intraoperatively identified SNs were excised. From the total of 237 removed SNs, 200 (84%) were found using PBD only. All 37 nodes that were not found with the PBD were localized with the probe so that the probe combined with PBD identified 99.5% of all SNs. In 23 patients the SN contained tumor. In three patients the SN was false-negative for metastasis.
Conclusion: The gamma probe together with PBD can identify more SNs (99.5%) than lymphatic mapping with PBD alone (84%).
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References
Balch CM, Soong SJ, Shaw HM, et al. Changing trends in the clinical and pathologic features of melanoma. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong SJ, eds.Cutaneous melanoma. 2nd ed. Philadelphia: JB Lippincott, 1992:40–5.
Veronesi U, Adamus J, Bandiera DC, et al. Inefficacy of immediate node dissection in stage I melanoma of the limbs.N Engl J Med 1977;297:627–30.
Veronesi U, Adamus J, Bandiera DC, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities.Cancer 1982;49:2420–30.
Sim FH, Taylor WF, Pritchard DJ, Soule EH. Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study.Mayo Clin Proc 1986;61:697–705.
Kroon BBR, Jonk A. Elective lymph node dissection in melanoma: still a controversial issue.Neth J Surg 1991;43:129–32.
Balch CM. The role of elective lymph node dissection in melanoma: rationale, results, and controversies.J Clin Oncol 1988;6:163–72.
Drepper H, Kohler CO, Bastian B, et al. Benefit of elective lymph node dissection in subgroups of melanoma patients.Cancer 1993;72:741–9.
Karakousis CP, Emrich LJ, Rao U. Groin dissection in malignant melanoma.Am J Surg 1986;152:491–5.
McNeer G, Das Gupta TK. Prognosis in malignant melanoma.Surgery 1964;56:512–8.
Urist MM, Maddox WA, Kennedy JE, Balch CM. Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients.Cancer 1983;51:2152–6.
Ames FC, Singletary SE. Cutaneous malignancies of the trunk and lower extremities. In: Johnson DE, Ames FC, eds.Groin dissection. Chicago: Year Book Medical, 1985:111–36.
Bowsher WG, Taylor BA, Hughes LE. Morbidity, mortality and local recurrence following regional node dissection for melanoma.Br J Surg 1986;73:906–8.
Baas PC, Schraffordt Koops H, Hoekstra HJ, Van Bruggen JJ, Van der Weele LT, Oldhoff J. Groin dissection in the treatment of lower-extremity melanoma. Short-term and long-term morbidity.Arch Surg 1992;127:281–6.
Morton DL, Wen D-R, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.
Thompson JF, McCarthy WH, Bosch CMJ, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes.Melanoma Res 1995;5:255–60.
Lingam MK, Mackie RM, Mackay AJ. Intraoperative lymphatic mapping using patent blue V dye to identify nodal micrometastases in malignant melanoma.Reg Cancer Treat 1994;7:144–6.
Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma metastases.Ann Surg 1994;220:759–67.
Krag DN, Meijer SJ, Weaver DL, et al. Minimal-access surgery for staging of malignant melanoma.Arch Surg 1995;130:654–8.
Essner R, Foshag L, Morton DL. Intraoperative radiolymphoscintigraphy: a useful adjunct of intraoperative lymphatic mapping and selective lymphadenectomy in patients with clinical stage I melanoma. Abstract presented at the Society of Surgical Oncology 47th Annual Meeting, Houston, 1994;47:104.
Godellas CV, Berman CG, Lyman G, et al. The identification and mapping of melanoma regional nodal metastases: minimally invasive surgery for the diagnosis of nodal metastases.Am Surgeon 1995;61:97–101.
Kapteijn BAE, Nieweg OE, Valdés Olmos RA, et al. Reproducibility of lymphoscintigraphy for lymphatic mapping in cutaneous melanoma.J Nucl Med 1996;37:972–975.
Mudun A, Murray D, Herda S, et al. Reproducibility of lymphoscintigraphy and intraoperative surgical probe use to identify the sentinel node in patients with melanoma [Abstract].J Nucl Med 1995;36:263.
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Kapteijn, B.A.E., Nieweg, O.E., Liem, I. et al. Localizing the sentinel node in cutaneous melanoma: Gamma probe detection versus blue dye. Annals of Surgical Oncology 4, 156–160 (1997). https://doi.org/10.1007/BF02303799
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DOI: https://doi.org/10.1007/BF02303799