Sentinel Node Navigation Surgery with Combination Method with Dye and Radioisotopes for Malignant Melanoma

聡, 高橋; 直也, 山崎; 明史, 山本; 公二, 吉野; 健二郎, 並川; 綾, 西澤; 浩明, 岩田; 幸浩, 中西; ゆう子, 笹島; 頌二, 照井

doi:10.2336/nishinihonhifu.68.274

Cited by 1 publication

(1 citation statement)

References 17 publications

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“…The detection rate was influenced by the location of the primary site, and was 93% in the groin region, 88% in the axilla, and 78% in the head and neck. The same trend was reported by Takahashi et al, but detection rates were 97% in the groin, 96% in the axilla, and 89% in neck region by a combination of blue dye and radionuclide 18 .…”

Section: Pathological Evaluationsupporting

confidence: 86%

Sentinel lymph node biopsy in Japan

2009

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Similar to western countries, intraoperative lymphatic mapping and selected lymphadenectomy (SNB) have been verified and are widely performed for staging of melanoma in Japan. Recent studies showed that approximately 90% (73/81) of university hospitals and several cancer hospitals routinely perform SNB, and half of melanoma patients receive this examination. SNB is performed according to a variation of the standard procedure described by Morton and Cochran. The most frequently used tracers are Tc 99m -tin colloid or Tc 99m -phytate for scintigraphy and patent blue violet or indigo carmine as a blue dye. Some institutions use indocyanine green, which is fluorescent and can be used to visualize sentinel lymph node(s) (SN) under an infrared camera. The recent detection rates of SN has increased to over 95% with the method using blue dye, lymphoscintigraphy, and a handheld gamma probe. In a multicenter study, the rates of metastasis in SN were as follows: pTis, 0% (0/36); pT1, 11.3% (6/56); pT2, 21.0% (13/63); pT3, 34.0% (35/103); and pT4, 62.4% (63/101). Metastasis rate was also significantly related with ulceration of the primary tumor. Here, we discuss data from Japanese patients and the present status of SNB in Japan.Introduction Lymph node metastasis is one of the most powerful predictors of recurrence and survival in patients with melanoma 1 . Therefore, elective lymph node dissection (ELND) has been widely used in the treatment of these patients. However, in several randomized controlled trials, overall survival benefits of ELND were not confirmed and ELND is becoming less common, especially in the USA 2 . In Japan, ELND had been accepted as the standard management in patients with primary tumors more than 3 mm in thickness. Intraoperative lymphatic mapping and selected lymphadenectomy (SNB) have made it possible to determine the lymphatic flow from a primary tumor and to identify its sentinel lymph node(s) (SN) in the regional basin 3,4 . This technique not only has lower morbidity than ELND but also permits more accurate and reliable staging. The new UICC/AJCC melanoma staging system has incorporated the pathological evaluation in SN into the new staging criteria for melanoma 1 . SLNB has been verified and is widely used as staging tool for melanoma in Japan. Here, we mainly discuss data from Japanese patients and the present status of sentinel node biopsy in Japan.

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Section: Pathological Evaluationsupporting

confidence: 86%