title: Influence of fast lymphatic drainage on metastatic spread in cutaneous malignant melanoma: a prospective feasibility study.
abstract: The concept of sentinel lymph node biopsy in cutaneous malignant melanoma is widely established. Preoperative cutaneous lymphoscintigraphic mapping is a reliable method for identifying the nodal basins at risk of metastases in melanomas. In this prospective study we investigated the correlation between the scintigraphic appearance time and the metastatic involvement of sentinel lymph nodes. In 276 malignant melanoma patients (137 women, 139 men; age 16-93 years), dynamic and static lymphoscintigraphy was performed after strict intracutaneous application of technetium-99m nanocolloid (40-150 MBq; 0.05 ml/deposit) around the tumour or biopsy scar. Analysis of dynamic scans primarily focussed on the appearance time of sentinel lymph nodes. Sentinel lymph node visualisation </=20 min post injection was defined as fast drainage, and visualisation >20 min as slow drainage. Fast lymphatic drainage was found in 236 patients, of whom 34 (14.4%) had sentinel lymph node metastases. Twenty-two patients showed hybrid (fast and slow) lymphatic drainage, and eight (36.4%) of them had sentinel lymph node metastases. Seven of the latter demonstrated fast lymphatic drainage, while one showed one positive sentinel lymph node with fast and another with slow drainage. The melanomas of 18 patients demonstrated exclusively slow lymphatic drainage, in all cases without sentinel lymph node metastases. This prospective study indicates that the scintigraphic appearance time of sentinel lymph nodes seems to be a clinically relevant factor for prediction of metastatic spread of cutaneous malignant melanoma. Larger numbers of patients need to be examined to truly assess the benefit of the scintigraphic appearance time compared with other predictors of sentinel lymph node tumour positivity.
authors.affiliation: Clinic for Nuclear Medicine, University Hospital Charité, Humboldt University of Berlin, Schumannstrasse 20-21, 10117, Berlin, Germany.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Maza
authors.forename: Ray
authors.initials: R
authors.lastname: Valencia
authors.forename: Lilli
authors.initials: L
authors.lastname: Geworski
authors.forename: Dirk
authors.initials: D
authors.lastname: Sandrock
authors.forename: Andreas
authors.initials: A
authors.lastname: Zander
authors.forename: Heike
authors.initials: H
authors.lastname: Audring
authors.forename: Erik
authors.initials: E
authors.lastname: Dräger
authors.forename: Helmut
authors.initials: H
authors.lastname: Winter
authors.forename: Wolfram
authors.initials: W
authors.lastname: Sterry
authors.forename: Dieter L
authors.initials: DL
authors.lastname: Munz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008208:Lymphatic System / Q000378:metabolism / Q000473:pathology; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid