Sentinel lymph node biopsy in cutaneous melanoma

Abstract

Purpose:To assess the importance of sentinel lymph node biopsy in patients with cutaneous melanoma. Methods: Ninety consecutive non-randomized patients with stages I and II melanoma who underwent sentinel lymph node biopsy were followed up prospectively for six years. Results: Patients were followed up for a mean period of 30 months. Their mean age was 53.3 years, ranging from 12 to 83 years. Thirty patients were male (37.5%) and 50, female (62.5%). Sentinel lymph node was positive in 32.5% and negative in 67.5%. It was found that the thicker the tumor, the greater the incidence of positive sentinel lymph nodes. In the group of patients with positive sentinel lymph nodes, recurrence occurred in 43.5%, but in those with negative sentinel lymph nodes, in only 7%, what points out to the association of tumor recurrence and positive sentinel lymph nodes. There were no major postoperative complications. Conclusion: Sentinel lymph node biopsy was demonstrated to be a safe method for selecting patients who need therapeutic lymphadenectomy. Key words: Melanoma. Lymph Nodes. Lymphatic Vessels. Diagnosis. RESUMOObjetivo: Avaliar a importância da biópsia do linfonodo sentinela em pacientes com melanoma cutâneo Métodos: Noventa pacientes com estadiamento I e II foram acompanhados prospectivamente no período de seis anos, de forma consecutiva e não randomizada e submetidos a biópsia do linfonodo sentinela. Resultados: Os pacientes foram acompanhados durante tempo médio de 30 meses. A média de idade dos pacientes foi de 53,3 anos, variando de 12 a 83. Quanto ao sexo, foram avaliados 30 pacientes do sexo masculino (37,5%) e 50 do sexo feminino (62,5%).32,5% dos pacientes apresentaram linfonodo sentinela positivo e 67,5% linfonodo sentinela negativos. Comparando-se a espessura tumoral com a positividade do LS, verificou-se que quanto maior a espessura, maior a incidência de positividade do linfonodo sentinela. No grupo de pacientes com LS positivo a recorrência surgiu em 43,5% dos casos, mostrando a relação entre a recorrência e a positividade do LS. Não houve complicações no pós-operatório.Conclusão: A biópsia do linfonodo sentinela mostrou-se um método seguro para selecionar os pacientes que necessitam de linfadenectomia terapêutica. Descritores: Melanoma. Linfonodos. Vasos Linfáticos. Diagnóstico.

Sentinel lymph node biopsy in rats. Comparison between paraffin and frozen section analysis

“…Following the same method, activated carbon was used at various concentrations to mimic the presence of metastases in the lymph node. The authors concluded that the lowest concentration used (0.5%) was the most suitable as it was possible to identify the carbon in all evaluations, without changing the visualization of the structures of the lymph node 8 .…”

“…In other words, the small fragment of the lymph node used in the frozen section analysis could contain the only metastases, and if not visualized could lead to a false negative diagnosis 8 . On the other hand, if it were possible to perform a frozen section examination during surgery, and it indicated that a lymph node dissection is necessary, there would be no need for a second hospitalization for lymphadenectomy, thus reducing morbidity, the cost of a second surgery and the stress of two hospitalizations.…”

“…Oliveira Filho described an experimental model in the adult rats demonstrating that sentinel lymph node biopsy is feasible 8 . Using this experimental model, Junqueira demonstrated that activated carbon can also be used as a marker, helping the pathologist in the search for metastases, without compromising the histological analysis of lymph nodes 9 .…”

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

“…Atualmente o uso combinado de marcadores corantes e radioativos estão clinicamente estabelecidos na cirurgia da mama e melanoma em fase inicial (EC T1/T2) para verificação de metástases linfonodais e estadiamento definitivo destes tumores 17,34 . É atribuído a Mikulics (1889) a idéia inicial da linfadenectomia extensa no CaG que na época declarou ser necessária também a remoção do pâncreas distal.…”

Linfonodo sentinela em melanoma: experiência inicial de um centro do nordeste brasileiro

“…Lymphatic mapping prior to surgery and selective lymphadenectomy of marked lymph nodes was first described by Morton in 1992 and is currently standard practice in the case of melanomas with Breslow depth > 1 mm or, irrespective of depth, for those with other characteristics such as Clark level > III or ulceration. [1][2][3][4] Biopsy of the SLN represents a significant advantage since the procedure is less invasive. Only 20% of individuals with a Breslow depth of 1-4 mm develop metastases.…”