Interval Nodes

Uren, Roger F.

doi:10.1001/archsurg.135.10.1168

Cited by 152 publications

(13 citation statements)

References 17 publications

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“…In some cases, it is difficult to determine if lymphatic channels flow into lymph nodes or just overlap lymph nodes. However, clinical recurrence might also occur in interval nodes that are sentinel lymph nodes if they are not subjected to biopsy during initial surgical treatment, and interval nodes not be overlooked if the sentinel lymph node biopsy procedure is to be as accurate as possible in all patients (Uren et al 2000). Therefore, careful observation with repetition and adjustment of window level and width is enormously needed.

Diagnostic confidence values of sentinel lymph node assessment of the lower extremities

…”

Section: Discussionmentioning

confidence: 99%

Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities

et al. 2014

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The aim of the present study was to confirm the contribution of dynamic images in sentinel lymphoscintigraphy in malignant skin neoplasms: precisely, to investigate if dynamic images were necessary and to observe if dynamic images could reduce the areas needed for biopsy and dissection. Twenty-five patients with malignant skin neoplasms of the lower (n = 21) and upper (n = 4) extremities were retrospectively investigated. Images were evaluated by two independent reviewers, an expert in diagnostic radiology and nuclear medicine and a diagnostic radiologist in training. Visualized hot spots were assessed to be sentinel nodes using only static planar images. Next, both static planar and dynamic images were assessed. Reviewers scored diagnostic confidence values of determined sentinel nodes as follows: 0, cannot be decided; 1, possible; 2, probable; and 3, definitive. Patterns of lymphatic drainage were categorized into six different pathways: (1) inguinal type, (2) popliteal type, (3) inguinal and popliteal type, (4) axillary type, (5) cubital type, and (6) axillary and cubital type. In cases in the lower extremities, with dynamic images, the expert reviewer changed assessment in three cases and the trainee reviewer changed it in one case. There were no cases in which a decision was changed to be the same between both reviewers. Although the average diagnostic confidence value of assessment is usually higher with dynamic images, significant differences were not present. In cases of the upper extremities, both reviewers changed their assessment in one patient. By mutual agreement, cases in which assessment was changed with dynamic images were the inguinal and popliteal type, and the axillary and cubital type. The expert reviewer noticed lymphatic channels only visualized on dynamic images and changed assessment. Determination of whether or not a lymph node is a sentinel node depends on visualization of the lymphatic network. In the present circumstances, all biopsies of hot spots determined to be lymph nodes should not be excluded. However, excessive biopsies should be avoided as much as possible. It is necessary to use dynamic images alongside skillful observation.

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Diagnostic confidence values of sentinel lymph node assessment of the lower extremities

…”

Section: Discussionmentioning

confidence: 99%

Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities

et al. 2014

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“…McMasters et al, with 99m Tc sulfur colloid radioactive agent, reported 3.1% of interval nodes [4]. Uren et al reported an incidence of interval nodes of 7.2% of patients using 99m Tc-labelled antimony trisulfide colloid that is a very small radioactive particle [3]. Roozendaal et al, like in our institution, used 99m Tc-labelled human albumin colloid, with an identification rate of interval nodes of 5.8% [9].…”

Section: Clinical Implication and Surgical Managementmentioning

confidence: 99%

“…Although most melanomas drain to the predicted classical anatomical basins (cervical, axillary, and inguinal nodes), some patients drain to lymph nodes in unpredicted sites, so-called interval nodes, aberrant nodes, intercalated, or unexpected nodes. These “not classical” sentinel nodes are those lymph nodes lying along the course of a lymphatic collecting vessel between the primary tumor site and the draining basin or that lymph nodes located in a nodal basin outside the anatomical predicted nodal field [3]. These peculiar sentinel nodes may contain micrometastatic disease and may be the only site of nodal involvement [4].…”

Section: Introductionmentioning

confidence: 99%

Lymphoscintigraphy Defines New Lymphatic Pathways from Cutaneous Melanoma Site: Clinical Implications and Surgical Management

Marone¹,

Aloj²,

Monta³

et al. 2011

Radiology Research and Practice

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Sentinel lymph node biopsy is commonly applied as staging procedure of regional lymph nodes in patients with cutaneous melanoma. Dynamic lymphoscintigraphy defines the lymphatic pathways from a primary melanoma site and allows to identify the node receiving lymphatic drainage from the primary tumor, which is the sentinel lymph node. In rare cases, lymphoscintigraphy shows sites of lymphatic drainage in nonclassical basins never described in the past when lymphatic drainage was considered only according to the anatomical proximity of the tumor primary site. These peculiar sentinel nodes, so-called “uncommon/interval” nodes, must be surgically removed because they may contain micrometastatic disease and may be the only site of nodal involvement.

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“…While most melanomas show lymphatic drainage to usual nodal basins (axillary, inguinal, and cervical regions), some patients also have drainage to lymph nodes outside these regions [5, 6, 9, 12]. Lymphatic nodes in the area between the primary melanoma and the regional basins are called “in-transit nodes”, “interval nodes”, or “interval sentinel lymph nodes”, and by definition are also SLNs [2–5, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Interval Sentinel Lymph Nodes: An Unusual Localization in Patients with Cutaneous Melanoma

Manganoni

Farfaglia

Sereni

et al. 2011

Dermatology Research and Practice

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Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined “interval nodes”. Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification.

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Interval Nodes

Cited by 152 publications

References 17 publications

Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities

Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities

Lymphoscintigraphy Defines New Lymphatic Pathways from Cutaneous Melanoma Site: Clinical Implications and Surgical Management

Interval Sentinel Lymph Nodes: An Unusual Localization in Patients with Cutaneous Melanoma

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