title: The definition of the sentinel lymph node in melanoma based on radioactive counts.
abstract: BACKGROUND
  There is no consensus on the definition of a hot, nonblue sentinel lymph node (SLN), despite the widespread use of radiocolloid in SLN mapping.
  
  
  METHODS
  A retrospective review of 592 patients with malignant melanoma who underwent SLN mapping was performed. Ex vivo SLN counts and nodal bed counts were obtained by using a gamma probe. The size of each metastatic deposit in an SLN was defined as macrometastases (>2 mm), micrometastases (< or =2 mm), a cluster of cells, or isolated melanoma cells.
  
  
  RESULTS
  A total of 1175 SLNs (SLN(-), n = 1041; SLN(+), n = 134) were evaluated. The mean SLN count/bed counts were SLN(-), 322 +/- 980 and SLN(+), 450 +/- 910 (not significant [NS]) (>2 mm, 270 +/- 792 [NS]; < or =2 mm, 446 +/- 693 [NS]; isolated melanoma cells/cluster of cells, 677 +/- 1189 [P =.036]). Overall, 16 (1.4%) of the SLNs collected had an overall ratio of < or =2. This included two positive SLNs (1.5%), both of which contained macrometastatic disease. Forty-seven positive nodal basins had at least one negative SLN. The hottest SLNs in these basins were negative for metastatic disease in nine cases (19.1%). In one basin (2.1%), the positive SLN count was <10% of the hottest lymph node count.
  
  
  CONCLUSIONS
  Removal of lymph nodes until the bed count is 10% of the hottest lymph node will remove 98% of positive SLNs. Lymph node tumor burden influences radioactive counts.
authors.affiliation: Departments of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. grant_carlson@emory.org
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.forename: Andrea
authors.initials: A
authors.lastname: Hestley
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*