Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye

Abstract

To decrease the miss rate, all SLNs with ≥10% of the ex vivo radioactivity of the "hottest" SLN should be removed and blue dye is not essential.

The Biology and Clinical Relevance of Sentinel Lymph Nodes in Melanoma

“…If blue dye is to be used, we suggest that the surgeon use as little blue dye as needed; we have found reliable results in head and neck melanoma using less than 1 cc per injection. Additionally, blue dye is not essential as we demonstrated in a recent study that using the 10% radioactivity rule (McMasters et al, 2001) with blue dye does not significantly decrease the Miss Rate when compared to the 10% radioactivity rule with technitium alone (Liu et al, 2011).…”

“…Given this data, the use of radiotracer is the most commonly use technique now. With greater surgical experience, the use of blue dye is not essential as radiotracer has a higher www.intechopen.com sensitivity than blue dye alone and this can avoid reported allergic reactions seen with the injection of blue dye (Leong et al, 2000;Liu et al, 2011). For this technique, filtered Tc99m sulfur colloid is injected intradermally at the primary melanoma site.…”

“…However, literature describes FN rates for SLN biopsy if only the single, "hottest" SLN is removed and the other nodes are left in place (McMasters et al, 2001). Thus, we and others use the 10% rule (Liu et al, 2011;McMasters et al, 2001): the gamma probe is applied and any SLNs that assessed ≥ 10% of the ex vivo radioactive count of "hottest" SLN are removed, including any blue nodes or suspicious nodes by digital palpation. After selective SLND, the wound is closed in layers.…”

The effect of delay time between primary melanoma biopsy and sentinel lymph node dissection on sentinel node status, recurrence, and survival

“…In the operating room, a hand-held gamma probe (Neoprobe 2000; Neoprobe Corp., Dublin, Ohio, USA) was used and any node that yielded at least 10% of the ex-vivo radioactive count of the 'hottest' sentinel node was removed and considered to be a sentinel node [10,11]. Nodes were examined by permanent sections [12].…”

In-Transit Intramammary Sentinel Lymph Nodes From Malignant Melanoma of the Trunk

“…In-transit and regional SLNs were identified intraoperatively as those with elevated radioactivity counts using a hand-held gamma probe (all lymph nodes harvested were considered "sentinel" if they had counts greater and or equal to the 10% of the maximum SLN count). 33,34 Resection bed counts were obtained to ensure removal of all SLNs. The technical details of SLN dissection have been previously described.…”