EANM-EORTC general recommendations for sentinel node diagnostics in melanoma

Chakera, Annette Hougaard; Hesse, Birger; Burak, Zeynep; Ballinger, James R.; Britten, A. J.; Caracò, Corrado; Cochran, Alistair J.; Cook, Martin; Drzewiecki, Krzysztof T.; Essner, Richard; Even-Sapir, Einat; Eggermont, Alexander; Stopar, Tanja Gmeiner; Ingvar, Christian; Mihm, Martin; McCarthy, Stanley W.; Mozzillo, Nicola; Nieweg, Omgo E.; Scolyer, Richard A.; Starz, Hans; Thompson, John F.; Trifirò, Gianluca; Viale, Giuseppe; Vidal-Sicart, Sergi; Uren, Roger F.; Waddington, W; Chiti, Arturo; Spatz, Alan; Testori, Alessandro

doi:10.1007/s00259-009-1228-4

Cited by 148 publications

(119 citation statements)

References 136 publications

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“…On the other hand, it is still controversial whether patients with lesions over 4 mm in thickness should undergo SNB because historical data indicated that these patients have a high rate of occult systemic metastasis at the time of initial presentation. The European Association of Nuclear Medicine-European Organization for Research and Treatment of Cancer (EANM-EORTC) recommend that SNB should be offered to patients with clinically localized disease, including melanomas over 4 mm in thickness 15 . In the institutions included in the present study, patients with melanomas > 4 mm thick were often candidates for SNB.…”

Section: Melanoma In Japanmentioning

confidence: 99%

Sentinel lymph node biopsy in Japan

2009

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Similar to western countries, intraoperative lymphatic mapping and selected lymphadenectomy (SNB) have been verified and are widely performed for staging of melanoma in Japan. Recent studies showed that approximately 90% (73/81) of university hospitals and several cancer hospitals routinely perform SNB, and half of melanoma patients receive this examination. SNB is performed according to a variation of the standard procedure described by Morton and Cochran. The most frequently used tracers are Tc 99m -tin colloid or Tc 99m -phytate for scintigraphy and patent blue violet or indigo carmine as a blue dye. Some institutions use indocyanine green, which is fluorescent and can be used to visualize sentinel lymph node(s) (SN) under an infrared camera. The recent detection rates of SN has increased to over 95% with the method using blue dye, lymphoscintigraphy, and a handheld gamma probe. In a multicenter study, the rates of metastasis in SN were as follows: pTis, 0% (0/36); pT1, 11.3% (6/56); pT2, 21.0% (13/63); pT3, 34.0% (35/103); and pT4, 62.4% (63/101). Metastasis rate was also significantly related with ulceration of the primary tumor. Here, we discuss data from Japanese patients and the present status of SNB in Japan.Introduction Lymph node metastasis is one of the most powerful predictors of recurrence and survival in patients with melanoma 1 . Therefore, elective lymph node dissection (ELND) has been widely used in the treatment of these patients. However, in several randomized controlled trials, overall survival benefits of ELND were not confirmed and ELND is becoming less common, especially in the USA 2 . In Japan, ELND had been accepted as the standard management in patients with primary tumors more than 3 mm in thickness. Intraoperative lymphatic mapping and selected lymphadenectomy (SNB) have made it possible to determine the lymphatic flow from a primary tumor and to identify its sentinel lymph node(s) (SN) in the regional basin 3,4 . This technique not only has lower morbidity than ELND but also permits more accurate and reliable staging. The new UICC/AJCC melanoma staging system has incorporated the pathological evaluation in SN into the new staging criteria for melanoma 1 . SLNB has been verified and is widely used as staging tool for melanoma in Japan. Here, we mainly discuss data from Japanese patients and the present status of sentinel node biopsy in Japan.

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Section: Melanoma In Japanmentioning

confidence: 99%

Sentinel lymph node biopsy in Japan

2009

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“…Meticulously performed lymphoscintigraphy is essential for reliable SLN biopsy and serves several purposes: to point out the draining lymph node field at risk for metastatic disease, to indicate the number of SLNs, to help distinguish first-tier nodes from secondary nodes, to detect SLNs in unpredictable locations, and to mark the location of the sentinel node on the skin. SLN biopsy identifies node-negative patients, for whom further treatment may not be indicated, thus reducing the number of unnecessary lymphadenectomies and avoiding complications such as lymphedema, delayed wound healing, infection, and pain (9,11). Furthermore, SLN biopsy can identify those clinically node-negative patients who actually have occult nodal metastases.…”

Section: Discussionmentioning

confidence: 99%

“…What is more, a greater variability in lymphatic drainage pathways has been reported in patients with cutaneous melanoma in the head and neck or trunk (9). In these previously mentioned works, the lymphoscintigraphic procedures were performed by the same investigator so as to avoid the potential variability of several different physicians performing the 2 studies.…”

mentioning

confidence: 99%

Accuracy and Reproducibility of Lymphoscintigraphy for Sentinel Node Detection in Patients with Cutaneous Melanoma

Vidal

Vidal-Sicart²,

Torrents³

et al. 2012

J Nucl Med

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Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.

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“…At the time of surgery, 2% patent blue violet or 0.4% indigocarmine was injected intradermally at the primary tumor site. Furthermore, in some hospitals, 0.5% fluorescent indocyanine green, which allows visualization of the SN with an infrared camera, 3 was concomitantly used in the combination of radiocolloid and blue dye. An incision was made on the skin site that was the most radioactive by the gamma probe.…”

Section: Methodsmentioning

confidence: 99%

“…Intraoperative lymphatic mapping and selected lymphadenectomy have made it possible to determine the lymphatic flow from a primary tumor and to identify its sentinel lymph node(s) (SN) in the regional basin [1][2][3] . Since its sixth edition, the AJCC/UICC melanoma staging system has incorporated the pathological evaluation in SN into the new staging criteria for melanoma 4) .…”

Section: Introductionmentioning

confidence: 99%