Sentinel lymph node biopsy for melanoma: is there a correlation of preoperative lymphatic mapping with sentinel lymph nodes harvested? Ann Plast Surg 2015 Apr;74(4):462-6
Date
03/10/2015Pubmed ID
25749211DOI
10.1097/SAP.0b013e3182a1e544Scopus ID
2-s2.0-84942895561 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Nodal status is the most significant prognostic factor in melanoma. No study has examined the relationship between lymphoscintigraphy, γ probe counts, harvested nodes, and nodal status.
METHODS: Two-hundred sixty two patients were identified who underwent sentinel lymph node biopsy for melanoma between 2001 and 2010. Clinicopathologic and treatment information was collected. The number of lymph nodes and basins demonstrated on lymphoscintigraphy was compared to those at surgery. γ Probe counts were compared.
RESULTS: Median age was 54.5 years (range, 18-90 years) with 52.3% male. Average Breslow depth was 2.0 (1.9) mm; 99.6% of lymphoscintigraphy studies identified at least 1 basin, 80% showed only 1 (range, 0-4). Lymphoscintigraphy identified on average 1.5 (0.9) sentinel nodes and 31% with secondary node. Surgery excised on average 2.6 (1.4) nodes involving 1.2 (0.5) basins; 17.6% had a positive sentinel lymph node. There was no difference in the sum or average of γ counts between positive and negative sentinel lymph node groups (P = 0.2, P = 0.5). When comparing lymphoscintigraphy and surgical excision, the correlation of lymphatic basins was r = 0.67 and of lymph node numbers was r = 0.33.
CONCLUSIONS: Lymphoscintigraphy should be used to identify the proper lymphatic basins for a sentinel node procedure, however, the removal of nodes must continue until the background count is less than 10%. The correlation of lymph node number identified on lymphoscintigraphy to surgical excision is weak. γ Probe counts cannot be used to differentiate positive from negative nodes and the positive lymph node is not always the hottest node.
Author List
Hudak KA, Hudak KE, Dzwierzynski WWAuthors
William W. Dzwierzynski MD Professor in the Plastic Surgery department at Medical College of WisconsinKristen Ann Klement MD Associate Professor in the Plastic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Female
Humans
Lymphatic Metastasis
Lymphoscintigraphy
Male
Melanoma
Middle Aged
Preoperative Care
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin Neoplasms
Young Adult
