Interval Sentinel Lymph Nodes in Melanoma

McMasters, Kelly M.; Chao, Celia; Wong, Sandra L.; Wrightson, William R.; Ross, Merrick I.; Reintgen, Douglas S.; Noyes, R. Dirk; Cerrito, Patricia B.; Edwards, Michael J.

doi:10.1001/archsurg.137.5.543

Cited by 126 publications

(113 citation statements)

References 27 publications

(29 reference statements)

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“…Several recent studies have confirmed that the path taken by the lymphatic collecting vessels is unpredictable, as is the ultimate location of the draining SNs. [1][2][3][4][5] Preoperative LS with small-particle radiocolloids allows visualization of lymphatic vessels that drain directly to the SNs. Careful imaging technique will thus allow all true SNs to be identified in each patient, even if these nodes lie outside standard node fields or are interval nodes lying between the primary site and a node field.…”

Section: Resultsmentioning

confidence: 99%

“…6). In a large multicenter study, McMasters and colleagues 3 found that in melanoma patients interval nodes were positive for metastases with the same frequency as SNs in standard nodal fields. In their 13 patients with a positive interval node, it was the only positive SN in 11 patients (85%).…”

Section: Interval Nodesmentioning

confidence: 98%

“…The pursuit of this goal has led to the discovery of several new lymphatic drainage pathways from the skin. [1][2][3][4][5] Several factors are critical for an accurate map of lymphatic drainage.…”

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confidence: 99%

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Lymphatic drainage of the skin

Uren

2004

Annals of Surgical Oncology

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A successful sentinel lymph node biopsy (SLNB) in melanoma patients requires an accurate map of the pattern of lymphatic drainage from the primary site. Lymphoscintigraphy (LS) can provide such a map. LS needs an understanding of lymphatic physiology, an appropriate small-particle radiocolloid, high-resolution collimators, and imaging protocols that detect all sentinel nodes (SNs). Patterns of lymphatic drainage from the skin are not clinically predictable. Unexpected drainage has been found from the skin of the back to SNs in the triangular intermuscular space (TIS) and the paraaortic, paravertebral, and retroperitoneal areas. It can also occur from the base of the neck up to nodes in the occipital or upper cervical areas or from the scalp down to nodes at the neck base, bypassing many node groups. Upper limb drainage can be to SNs above the axilla. Interval nodes not uncommonly can be SNs, especially on the trunk. Lymphatic drainage may involve SNs in multiple nodal fields, and drainage across the midline of the body is quite common. Because micrometastatic disease can be present in any SN regardless of its location, all true SNs must be biopsied. LS is an important first step to ensure this goal is achieved.

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Section: Resultsmentioning

confidence: 99%

Section: Interval Nodesmentioning

confidence: 98%

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Lymphatic drainage of the skin

Uren

2004

Annals of Surgical Oncology

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“…'Interval', 'intercalated' veya 'in transit' olarak adlandırılan bu lenf nodları, deri altında hatta kas içinde dahi görülebilir. Üst ve alt ekstremitenin distalindeki lezyonlar için epitroklear ve popliteal bölgelerin de mutlaka değerlendirilmesi gerekir (23,24).…”

Section: Slnb Teknik Detaylarıunclassified

Sentinel Lymph Node Biopsy in Malignant Melanoma: Current Approaches

Uzun¹,

Bitik²

2014

Acta Oncol Tur.

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ÖZETSentinel lenf nodu biyopsisi (SLNB), malign melanomlu hastaların lenf nodlarının durumunu belirlemek için kullanılan bir evreleme prosedürüdür. Elektif lenf nodu diseksiyonuna göre çok daha az komplikasyon riski bulunmaktadır. SLNB, Breslow kalınlığı <0.75 mm. olan hastalara önerilmemektedir. Teknesyum sülfür kolloid ve vital mavi boyanın birlikte kullanılması ile yapılan lenfatik haritalama sonucu sentinel lenf nodu %99 oranında tespit edilebilir. SLNB, klinik olarak lenf nodu metastazı olmayan malign melanomlu hastalarda en önemli prognostik faktördür. SLNB'de mikrometastaz tespit edilmesi, tamamlayıcı lenf nodu diseksiyonu endikasyonudur. Bu derlemede SLNB hakkında hem güncel literatür bilgisi hem de süregelen tartışmalar ele alınmıştır. Anahtar Kelimeler: malign melanom, sentinel lenf nodu, lenfosintigrafi. ABSTRACT Sentinel lymph node biopsy (SLNB) is a staging procedure used to determine the nodal status of patients with melanoma. It has a significantly lower complication rate compared with elective lymph node dissection. SLNB is not recommended for very thin lesions (Breslow thickness ≤ 0.75 mm). The combined lymphatic mapping technique of technetium sulfur colloid with vital blue dye would result in identification of the sentinel node in 99% of patients when performed correctly. SLNB is the single most important prognostic factor in melanoma patients without clinical evidence of nodal metastasis Currently, micrometastatic disease found on SLNB is an indication for completion lymph node dissection. In this review, both current literature and ongoing debates considering SLNB are discussed.

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“…To rule out any interval lymphadenopathy (ie, any nonregional lymphatic station placed along the pathway of the melanoma spread), 22,23 we also routinely explore the retroareolar and the upper external lump portion in patients with primary Figure 4. Iliac lymphadenopathy in a patient with previous inguinal radical lymphadenectomy: importance of a wide sonographic exploration.…”

mentioning

confidence: 99%

Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

Catalano

Setola

Vallone

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Sonography is being used with increasing frequency in the assessment of locoregional tumor spread in patients with melanoma. Nevertheless, to maximize its practical impact, sonography should be performed with state-of-the-art equipment, by specifically trained operators, and using a careful exploration technique and well-defined diagnostic criteria. In this "how I do it"-type article, we illustrate our practical approach to sonography of cutaneous melanoma. Methods. We first illustrate the basic and advanced technical requirements; then we describe our exploration methods and our image interpretation approach; and finally, we report on our use of sonography as a guidance tool for interventional procedures. Special emphasis is given to methodological and interpretative clues, tricks, and pitfalls. Results. Sonography can be used in the initial staging of patients with melanoma, particularly in the screening of patients scheduled for a sentinel lymph node biopsy procedure. Additionally, sonography can be used during patient follow-up to detect locoregional recurrence earlier than palpation. Conclusions. Sonography plays a growing role in the assessment of the superficial spread of melanoma. Nevertheless, state-of-the-art equipment and careful exploration by trained operators are necessary.

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Interval Sentinel Lymph Nodes in Melanoma

Cited by 126 publications

References 27 publications

Lymphatic drainage of the skin

Lymphatic drainage of the skin

Sentinel Lymph Node Biopsy in Malignant Melanoma: Current Approaches

Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

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