Localizing the sentinel node in cutaneous melanoma: Gamma probe detection versus blue dye

Kapteijn, B. A. E.; Nieweg, Omgo E.; Liem, Ing Han; Mooi, Wolter J.; Balm, Alfons J. M.; Müller, Sara; Peterse, Johannes L.; Olmos, Renato A. Valdés; Hoefnagel, Cornelis A.; Kroon, Bin B. R.

doi:10.1007/bf02303799

Cited by 159 publications

(77 citation statements)

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“…24,25 When using only PBD, the literature has registered a lower identification rate for the SN (85%) than with GPD (98-100%). [26][27][28][29] Similar data were obtained in our study (PBD = 76% and GPD = 97%). Subgroup analysis of the basins showed that GPD and PBD identified 100% of the inguinal SN.…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2000

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a b s t r a c tCONTEXT: Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. OBJECTIVE:Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. DESIGN:Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. SETTING:Patients were seen at Hospital São Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology).PATIENTS: 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. INTERVENTIONS:Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD was performed on all patients. The SN was examined by conventional and immunohistochemical staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. MAIN MEASUREMENTS:The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. RESULTS:Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage in 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up = 11 months). CONCLUSION:Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins.

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Section: Discussionsupporting

confidence: 90%

“…Some authors have questioned whether there is any role for PBD in the SN biopsy, 27 emphasizing the role of GPD in the outpatient clinic. Others indicate PBD as a standard procedure.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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“…Intraoperative sentinel node identification traditionally relies on the combination of acoustic signals generated by a g-ray detection probe and optical sentinel node visualization using a visible blue dye (12,13). Because the probe has a limited spatial resolution and sentinel nodes do not always stain blue, sentinel nodes can be difficult to localize in areas with a complex anatomy and when sentinel nodes are near the injection site (14,15).…”

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confidence: 99%

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

Brouwer¹,

Buckle²,

Vermeeren³

et al. 2012

J Nucl Med

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The purpose of this study was to compare the lymphoscintigraphic drainage patterns of a hybrid sentinel node tracer consisting of the fluorescent dye indocyanine green (ICG) and 99m Tc-nanocolloid with the drainage pattern of 99m Tc-nanocolloid alone, the current standard tracer in many European countries. Methods: Twenty-five patients with a melanoma in the head and neck region (n 5 10), a melanoma on the trunk (n 5 6), or penile carcinoma (n 5 9) who were scheduled for sentinel node biopsy were prospectively included. First, the standard 99m Tc-nanocolloid procedure was performed. After injection at the lesion site, lymphoscintigraphy was performed with a 10-min dynamic study and static planar images at 10 min and 2 h after injection, followed by SPECT/CT. The same scintigraphic procedure was repeated after injection of hybrid ICG-99m Tcnanocolloid the same afternoon in 10 patients or the next morning in 15 patients. The paired images of both injections were evaluated, and count rates in the sentinel nodes were calculated and compared. Sentinel nodes were surgically localized using blue dye, a g-ray detection probe, a portable g-camera, and a fluorescence camera. Results: Lymphatic drainage was visualized in all 25 patients using 99m Tc-nanocolloid, leading to the identification of 66 sentinel nodes in total. These same sentinel nodes were also identified during the second scintigraphic procedure with ICG-99m Tc-nanocolloid. Moreover, a high correlation between the radioactive counting rates in the sentinel nodes of both scintigraphic studies was observed (mean R 2 5 0.83). Intraoperatively (4-23 h after the second injection), all preoperatively identified sentinel nodes could be localized using radio-and fluorescence guidance combined. In total, 95% of the sentinel nodes could be intraoperatively visualized by means of fluorescence imaging, whereas merely 54% stained blue. Ex vivo, all radioactive sentinel nodes were fluorescent and vice versa. No adverse reactions were observed. Conclusion: The lymphatic drainage pattern of ICG-99m Tc-nanocolloid is identical to that of 99m Tc-nanocolloid. This observation, together with the added value of intraoperative fluorescence guidance, warrants wider evaluation of hybrid ICG-99m Tc-nanocolloid as a tracer for sentinel node procedures.

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“…9,10 An additional technique, intraoperative use of the gamma probe, permits surgeons to evaluate intervening regions between the primary tumor and the standard lymph node basin and to identify SLNs in unusual locations. 3,5,[11][12][13][14] The significance of SLNs located in these unusual locations, however, has not been established completely. If these SLNs harbor metastatic disease, failure to evaluate them would lead to understaging the patient, alter treatment recommendations (i.e., the patient may not be offered indicated adjuvant therapy), and may result in an increased risk of regional or distant recurrence.…”

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Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma

Sumner

Ross

Mansfield

et al. 2002

Cancer

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BACKGROUNDSentinel lymphadenectomy reliably identifies the first site(s) of regional lymphatic drainage and, therefore, the most likely lymph nodes to contain occult metastasis in patients with primary cutaneous melanoma. Although in most patients lymphatic drainage from the primary melanoma first reaches a standard lymph node basin, a sentinel lymph node (SLN) may be identified in an unusual location. The objective of this study was to determine the frequency and significance of unusual sentinel lymph node drainage patterns in a large cohort of patients with primary melanoma.METHODSThe records of 1145 consecutive primary melanoma patients who underwent SLN biopsy were reviewed. Preoperative lymphoscintigraphy was performed in all patients with truncal melanoma and in many patients with distal extremity lesions. Unusual lymph node sites were defined as epitrochlear, popliteal, or ectopic/interval (in‐transit or any other nonstandard lymph node‐bearing area).RESULTSAt least one SLN was harvested in 1117 patients (98%). SLN biopsy of an unusual lymph node site was attempted in 59 patients (5%). Successful intraoperative localization and biopsy was performed in 54 (92%) of 59 patients for a total of 56 unusual sites. Of these, 7 (13%) were popliteal, 8 (14%) were epitrochlear, and 41 (73%) were ectopic/interval. Preoperative lymphoscintigraphy was performed in 41 of these 54 patients and correctly identified unusual SLN locations in 12 (29%); the majority of unusual SLNs were identified only with the assistance of the intraoperative gamma probe. In four patients (7%), the unusual lymph node site was the only site from which SLNs were harvested. In the remaining 50 patients (93%), biopsies were performed on SLNs from both unusual sites and from a standard lymph node basin. Among the 54 patients who underwent a SLN biopsy of an unusual nodal site, 7 (13%) had lymph node metastases in that location. In four of the seven patients, the only positive SLN was from the unusual site.CONCLUSIONSSentinel lymphatic drainage patterns include lymph node‐bearing areas that may be outside established standard lymph node basins and may represent the only site of regional lymph node metastases. Although preoperative lymphoscintigraphy may assist in the identification of unusual SLN drainage patterns, intraoperative use of the gamma probe is recommended to identify accurately and completely all sites of regional lymph node drainage. Cancer 2002;95:354–60. © 2002 American Cancer Society.DOI 10.1002/cncr.10664

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Localizing the sentinel node in cutaneous melanoma: Gamma probe detection versus blue dye

Abstract: The gamma probe together with PBD can identify more SNs (99.5%) than lymphatic mapping with PBD alone (84%).

Cited by 159 publications

References 14 publications

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

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

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma

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Localizing the sentinel node in cutaneous melanoma: Gamma probe detection versus blue dye

Abstract: The gamma probe together with PBD can identify more SNs (99.5%) than lymphatic mapping with PBD alone (84%).

Cited by 159 publications

References 14 publications

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

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

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–99mTc-Nanocolloid with 99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma

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Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT