title: Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanoma.
abstract: BACKGROUND
  The sentinel lymph node (SLN), the first node draining the primary tumor site, has been shown to reflect the histologic features of the remainder of the lymphatic basin in patients with melanoma. Intraoperative localization of the SLN, first proposed by Morton and colleagues, has been accomplished with the use of a vital blue dye mapping technique. Technical difficulties resulting in unsuccessful explorations have occurred in up to 20% of the dissections.
  
  
  OBJECTIVE
  The authors aimed to define the SLN using gamma detection probe mapping and to determine whether intraoperative radiolymphoscintigraphy using technetium sulfur colloid and a hand-held gamma-detecting probe could be used to improve detection of all SLNs for patients with melanoma.
  
  
  METHODS
  To ensure that all initial nodes draining the primary site were removed at the time of selective lymphadenectomy, the authors used intraoperative radiolymphoscintigraphy to confirm the location of the SLN, which was determined initially with the preoperative lymphoscintigram and the intraoperative vital blue dye injection.
  
  
  METHODS
  The patient population consisted of 106 consecutive patients who presented with cutaneous melanomas larger than 0.75 mm in all primary site locations.
  
  
  RESULTS
  The preoperative lymphoscintigram revealed that 22 patients had more than one lymphatic basin sampled. Two hundred SLNs and 142 neighboring non-SLNs were harvested from 129 basins in 106 patients. After the skin incision was made, the mean ratio of hot spot to background activity was 8.5:1. The mean ratio of ex vivo SLN-to-non-SLN activity for 72 patients who had SLNs harvested was 135.6:1. When correlated with the vital blue dye mapping, 139 of 200 (69.5%) SLNs demonstrated blue dye staining, whereas 167 of 200 (83.5%) SLNs were hot according to radioisotope localization. With the use of both intraoperative mapping techniques, identification of the SLN was possible for 124 of the 129 (96%) basins sampled. Micrometastases were identified in SLNs of 16 of the 106 (15%) patients by routine histologic analysis.
  
  
  CONCLUSIONS
  The use of intraoperative radiolymphoscintigraphy can improve the identification of all SLNs during selective lymphadenectomy.
authors.affiliation: Cutaneous Oncology Program, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Albertini
authors.forename: C W
authors.initials: CW
authors.lastname: Cruse
authors.forename: D
authors.initials: D
authors.lastname: Rapaport
authors.forename: K
authors.initials: K
authors.lastname: Wells
authors.forename: M
authors.initials: M
authors.lastname: Ross
authors.forename: R
authors.initials: R
authors.lastname: DeConti
authors.forename: C G
authors.initials: CG
authors.lastname: Berman
authors.forename: K
authors.initials: K
authors.lastname: Jared
authors.forename: J
authors.initials: J
authors.lastname: Messina
authors.forename: G
authors.initials: G
authors.lastname: Lyman
authors.forename: F
authors.initials: F
authors.lastname: Glass
authors.forename: N
authors.initials: N
authors.lastname: Fenske
authors.forename: D S
authors.initials: DS
authors.lastname: Reintgen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016010:Binomial Distribution; D001706:Biopsy; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011877:Radionuclide Imaging; D012394:Rosaniline Dyes; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D012394:Rosaniline Dyes; D013671:Technetium Tc 99m Sulfur Colloid; C008769:sulfan blue