Surgical management of aberrant sentinel lymph node drainage in cutaneous melanoma

Lieber, Kimberly A.; Standiford, Steven B.; Kuvshinoff, Boris W.; Ota, David M.

doi:10.1067/msy.1998.90943

Cited by 44 publications

(19 citation statements)

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“…In contrast, our study, as well as those by Uren et al 9 and Roozendaal et al, 17 showed that patients with truncal lesions were more likely to have unusual drainage. The definition of unusual lymph node drainage (i.e., epitrochlear, supraclavicular, or popliteal lymph nodes for extremity lesions and intramuscular lymph nodes for truncal and head and neck lesions) used by Lieber et al 22 differs slightly from that used in our study and may partially account for the difference in findings.…”

Section: Discussioncontrasting

confidence: 55%

“…Abnormally located SLNs were observed among patients with primary tumors of the trunk (8%), upper extremity (7%), and lower extremity (2%) with a frequency similar to that found in the current study. Lieber et al 22 described a series of 32 patients, 7 (22%) of whom had unusual drainage. Only two unusual SLNs were found in patients with truncal melanoma; the remaining five were found in patients with extremity lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Uren et al 21 also reported specifically on their experience with popliteal lymph node metastasis, which they found to be an extremely uncommon event (0.31%). Tanabe, 23 Roozendaal et al, 17 and Leiber et al 22 described patients with isolated epitrochlear and popliteal metastases at the time of SLN biopsy. Vidal-Sicart et al 18 described a patient in whom two midarm SLNs were harvested.…”

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confidence: 99%

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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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confidence: 55%

Section: Discussionmentioning

confidence: 99%

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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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“…If only used to correct the radionuclide image for photon attenuation, the CT data can be acquired with a considerably lower statistical quality and coarser spatial resolution than required for diagnostic-quality imaging and therefore can deliver a significantly lower radiation dose than that for a diagnostic CT study [37]. Low radiation dose is added to the scintigraphic mapping by the low-dose CT, ranging from 1.3 mGy at the centre to 5 mGy at the surface of the body [36,40]. According to low-dose scanning protocol we evaluated the radiation exposure from spiral CT to about 1.5 millisieverts (mSv).…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph nodes and planar scintigraphy and SPECT/CT in various types of tumours. Estimation of some factors influencing detection success

Kraft

Havel²

2013

Nucl. Med. Rev.

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“…Low radiation dose is added to the scintigraphic mapping by the low-dose CT, ranging from 1.3 mGy at the centre to 5 mGy at the surface of the body [19,30] . According to low-dose scanning protocol we have evaluated the radiation exposure from spiral CT to about 1.5 millisieverts (mSv).…”

Section: Discussionmentioning

confidence: 99%

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Kraft

Havel

2012

JBGC

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Background: The most important prognostic factor in melanomas, breast cancers and gynecologic tumors is the state of the lymph nodes (LNs). There is not suitable pre-surgery examination procedure of detection of impacted LNs. The use of lymphatic mapping of sentinel lymph node (SLN) helps reduce the morbidity of surgery. Accurate visualization of the SLN is required for the best results. The aim is to assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in SLN detection in patients with various types of tumors and estimation of some factors influencing detection success -age, gender and body mass index (BMI). Methods:Planar scintigraphy and hybrid modality SPECT/CT were performed in 550 patients (pts) (mean age 58.1 ± 13.1 years): 69 pts with gynecological tumors (37 with cervical cancer, 25 pts with endometrial cancer, 7 pts with vulvar carcinoma); in 161 pts with melanomas; and in 318 women and 2 men with breast cancer. The radiopharmaceutical was injected around the tumor, subareolar or around the scar. Planar and SPECT/CT images were interpreted separately by two nuclear medicine physicians. Efficacy of these two techniques to image SLN were compared. We have estimated the influence of the age, gender and BMI on the succes rate of SLN detection. Student's paired t-test was used for comparing numbers of found SLN by both techniques; F-test, Student's t-test, and Fisher's exact test were utilized for age, gender and BMI characteristics comparisons. Values were considered significant when P<0.05. Results:Planar scintigraphy did not image SLN in 77 pts in total (14.0 %); in 8 pts with gynecologic tumors, in 23 pts with melanomas and in 46 pts with breast cancer. SPECT/CT was negative in 49 pts (8.9 %) in total; in 4 pts with gynecologic tumors, in 12 pts with melanomas and in 33 pts with breast cancer. In 199 (36.2 %) pts the number of SLNs captured on SPECT/CT was higher than on planar imaging. 35 foci of uptake (3.1 % from totally visible 1134 foci on planar images) interpreted on planar images as hot LNs were found to be false positive non-nodal sites of uptake when further assessed on SPECT/CT. Influence of the age, gender and BMI: The group of patients with higher number of detected SLN on SPECT/CT than on planar scintigraphy had lower average age than the group of patients with the same number of detected SLN on SPECT/CT and on planar scintigraphy, the difference was statistically significant (P=0.008). BMI did not differ in these two groups. There has been proportionally higher number of men than women who have had higher detected SLNs on SPECT/CT than on planar scintigrams (difference statistically significant P=0.04). It follows that gender influences the difference of detected SLNs on SPECT/CT and planar scintigraphy in favor of male gender. Conclusion:In some patients with gynecologic, including breast cancers and melanomas SPECT/CT improves detection of SLNs as compared to planar scintigraphy. It can image nodes not visible on planar scintigrams, excludes false positiv...

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Surgical management of aberrant sentinel lymph node drainage in cutaneous melanoma

Cited by 44 publications

References 9 publications

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

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

Sentinel lymph nodes and planar scintigraphy and SPECT/CT in various types of tumours. Estimation of some factors influencing detection success

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

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