Less false‐negative sentinel node procedures in melanoma patients with experience and proper collaboration

Abstract

The sentinel node procedure failed to identify involvement in 5.7% of the patients with lymph node metastases. Half of the false-negative biopsies took place in the first year after the procedure was introduced, illustrating the existence of a learning period.

Association Between Sentinel Lymph Node Excision With or Without Preoperative SPECT/CT and Metastatic Node Detection and Disease-Free Survival in Melanoma

“…15,27 In the axilla and groin, however, the reported falsenegative rate is very high and varies between 5.7% and 32.0%, respectively. 24,28 In our study, we were able to demonstrate the reliability and effectiveness of preoperative SPECT/CT imaging for all SLNE without preselection by anatomical site (Table 1 and Figure 2, with an example for cervical, axillary, popliteal, and inguinal SLN). With the SPECT/CT-guided SLNE, we removed more SLNs (2.40 SLNs per patient) than in the standard cohort (1.87 SLNs per patient, PϽ.001), which is consistent with previous studies.…”

“…24 The falsenegative rate was defined as the ratio of false-negative results to the total number of positive nodes (falsenegative nodes plus true-positive nodes). 25 …”

EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

“…There is a learning phase for a lymphatic mapping team. A recent study at a specialized melanoma centre showed a 5.7 % false-negative rate over a 15-year period, but the rate was 29.4 % in the first year [66]. Various durations of learning phases have been recommended but none has been based on sound scientific data [67].…”

“…SLNB should be performed by a qualified team of nuclear medicine specialists, surgeons and pathologists acting in close collaboration. The success of SLNB continues to increase as a centre gains experience [26,66,68,69].…”

“…Analysis of false-negative procedures has revealed that the cause may lie with each of its three elements [66,70,71]. Causative factors in lymphoscintigraphy may be imaging of the wrong nodal basin, or failure to depict all potential drainage basins, failure to visualize the afferent lymph vessel, or failure to detect an SLN in an unusual location.…”