Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

Filho, Renato Santos de Oliveira; Santos, Ivan Dunshe Abranches Oliveira; Ferreira, Lydia M.; Almeida, Fernando Augusto de; Enokihara, Milvia Maria Simões e Silvia; Barbieri, Antônio; Filho, Reinaldo Tovo

doi:10.1590/s1516-31802000000600003

Cited by 13 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous study had suggested similar results. 16 Lymphoscintigraphy has a crucial role in localizing the SN basin and allowing skin localization of the SN. In case of inguinal sentinel node, deep pelvic and popliteal SN has to be checked by lymphoscintigraphy.…”

Section: Discussionmentioning

confidence: 99%

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

et al. 2006

Self Cite

View full text Add to dashboard Cite

Purpose:The importance of gamma probe detection (GPD) combined with vital dye for sentinel node (SN) biopsy is well accepted. We evaluated the efficacy of patent blue dye (PBD) in identifying inguinal SN. Methods: Ninety-four cutaneous melanoma patients with inferior extremity lesions were submitted to SNB according to a established protocol. Patients were randomized in two groups: Blue group, where SN was identified by PPD and Probe group, where SN was identified by GPD. The median age was 44.2 years and median Breslow thickness was 2.1 mm. Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intra-operative GPD was performed on all patients. Histological examination of SN consisted of hematoxylin-eosin and immunohistochemical staining. If micrometastases were present complete lymphadenectomy was performed. The SN was considered as identified by PBD if it was blue and identified by GPD if it demonstrated at least ten times greater radioactivity than background. Results: It was explored 94 inguinal lymphatic basins, 145 SN were excised (70 guided primarily by blue dye and 75 guided primarily by probe). All SN identified by preoperative lymphoscintigraphy were excised. In the Blue group PPD identified all SN and all of them were hot. In the Probe group all SN were identified by probe and were blue. The coincidence of PPD and GPD was 100%. Conclusion: Patent blue dye is enough to identify superficial inguinal SN in cutaneous melanoma. Key words: Dyes. Lymphatic Vessels. Probe. Lymph Nodes. Melanoma. RESUMOObjetivo: a importância da detecção gama intra-operatória combinada com corante vital para biópsia de linfonodo sentinela é bem aceita. Nós avaliamos a eficácia do azul patente V na identificação do linfonodo sentinela inguinal. Métodos: Noventa e quatro pacientes portadores de melanoma cutâneo de membro inferior foram submetidos a biópsia de linfonodo sentinela de acordo com protocolo estabelecido. Foram randomizados em dois grupos: Grupo Azul, onde o linfonodo sentinela foi identificado primariamente com o corante vital azul patente V (Guerbet) e o Grupo Sonda, onde o linfonodo sentinela foi identificado primariamente pela sonda de detecção gama (Neoprobe). A idade mediana foi de 44,2 anos e a espessura mediana de Breslow foi 2,1 mm. Linfocintilografia pré-operatória, mapeamento linfático com azul patente V e detecção gama intra-opertaória foram realizados em todos os pacientes. O exame histopatológico do linfonodo sentinela consistiu de hematoxilina-eosina e imunohistoquímica. Se micrometástase estivesse presente, linfadenectomia completa era realizada. O linfonodo sentinela era considerado como identificado pelo corante vital se estivesse azul e identificado pela sonda de detecção gama se demonstrasse pelo menos 10 vezes ou mais radioatividade do que o fundo. Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients linfonodos sentinelas foram primariamente identificados pela sonda e estavam corados pelo azul. A coincidência da sonda com o corante vital foi de 100%. ...

show abstract

Section: Discussionmentioning

confidence: 99%

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

et al. 2006

Self Cite

View full text Add to dashboard Cite

show abstract

“…The proportion of thin melanoma has increased as compared to more deeply infiltrating lesions (1)(2)(3). Sentinel node (SN) biopsy proved to be an accurate staging procedure of regional nodal status with minimal morbidity and SN status is the most important prognostic factor for localized melanoma (4,5).…”

mentioning

confidence: 99%

Vertical growth phase and positive sentinel node in thin melanoma

Filho

Ferreira

Biasi

et al. 2003

Braz J Med Biol Res

View full text Add to dashboard Cite

Sentinel node (SN) status is the most important prognostic factor for localized melanoma. Usually, patients with Breslow thickness of less than 1.0 mm are not included in SN protocols. However, the literature presents a rate ranging from 3 to 7% of nodal recurrence in thin melanoma. Ulceration, regression and high mitotic rate have been considered to be indications for an SN biopsy. The metastatic potential of the vertical growth phase is uncertain. To correlate pathological features in thin melanoma with SN metastasis, we reviewed 358 patients submitted to SN biopsy. Seventy-seven patients with lesions of 1 mm or smaller were included in the study group. Histological evaluation of the primary tumor included thickness, Clark level, mitotic rate, ulceration, regression, and growth phase. Lymphoscintigraphy was performed on all patients. Lymphatic mapping and gamma probe detection were both used for SN biopsy. Histological examination of SN consisted of hematoxylin-eosin and immunohistochemical staining. Median follow-up was 37 months. Six patients had micrometastases. Statistical analysis by the Fisher test showed that ulceration (P = 0.019), high mitotic rate (P = 0.008) and vertical growth phase (P = 0.002) were positively correlated with micrometastases. If other studies confirm these results, more melanoma patients must be submitted to SN biopsy.

show abstract

“…[5][6][7] In 1993, Alex et al 8 injected technetium and introduced the technique of gamma probe-guided surgery to identify the sentinel node. In the same year, Krag et al 9 published a study on sentinel node using Technetium-99 (Tc99) associated with the use of probes for detection of gamma rays in breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye

Aquino¹,

Pinheiro²,

Vasques³

et al. 2012

Acta Cir. Bras.

View full text Add to dashboard Cite

PURPOSE: This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches. METHODS: 0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5%) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN). RESULTS: It was observed that 88% of SLN were identified. It wasn´t found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88%) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation). CONCLUSION: The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

show abstract

Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

Cited by 13 publications

References 26 publications

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

Vertical growth phase and positive sentinel node in thin melanoma

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye

Contact Info

Product

Resources

About