title: Failure to remove true sentinel nodes can cause failure of the sentinel node biopsy technique: evidence from antimony concentrations in false-negative sentinel nodes from melanoma patients.
abstract: We have recently found that antimony (originating from the technetium 99m antimony trisulfide colloid, used for preoperative lymphoscintigraphy) can be measured in tissue sections from archival paraffin blocks of sentinel nodes (SNs) by means of inductively coupled plasma mass spectrometry (ICP-MS) to confirm that removed nodes are true SNs. We performed a retrospective analysis of antimony concentrations in all our false-negative (FN) SNs to determine whether errors in lymphadenectomy (i.e., failure to remove true SNs) may be a cause of FN SN biopsies (SNBs). Among 27 patients with an FN SNB, metastases were found on histopathologic review of the original slides or additional sections in 7 of 23 patients for which they were available; however, antimony concentrations were low in 5 of 20 presumptive SNs. Our results suggest that an FN SNB can occur because of failure to remove the true SN as well as histopathologic misdiagnosis.
authors.affiliation: Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, Camperdown, Australia. richard.scolyer@email.cs.nsw.gov.au
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Ling-Xi L
authors.initials: LX
authors.lastname: Li
authors.forename: Alison
authors.initials: A
authors.lastname: Beavis
authors.forename: Michael
authors.initials: M
authors.lastname: Dawson
authors.forename: Phillip
authors.initials: P
authors.lastname: Doble
authors.forename: Vivian S K
authors.initials: VS
authors.lastname: Ka
authors.forename: J Gregory
authors.initials: JG
authors.lastname: McKinnon
authors.forename: Robyne
authors.initials: R
authors.lastname: Soper
authors.forename: Roger F
authors.initials: RF
authors.lastname: Uren
authors.forename: Helen M
authors.initials: HM
authors.lastname: Shaw
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.forename: Stanley W
authors.initials: SW
authors.lastname: McCarthy
mesh_terms: D000965:Antimony / Q000032:analysis*; D003102:Colloids; D003951:Diagnostic Errors; D005188:False Negative Reactions; D006801:Humans; D008198:Lymph Nodes / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000556:secondary*; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D017556:Technetium Compounds / Q000032:analysis*
chemical_list: D003102:Colloids; D017556:Technetium Compounds; C019096:technetium Tc 99m antimony sulfide; D000965:Antimony