Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center.
OBJECTIVE
To describe one center's experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival malignancies performed with a smaller volume of technetium than was initially used and a small incision directly overlying the sentinel node(s).


METHODS
A noncomparative interventional case series of 13 patients with clinically negative regional lymph nodes who underwent SLN biopsy for eyelid or conjunctival malignancies at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003. Preoperative lymphoscintigraphy was performed with an injection of 0.3 mCi of technetium Tc-99m sulfur colloid in a volume of 0.2 mL. Images were taken as soon as the first SLN was detected through the gamma camera. Intraoperative mapping was performed with the same volume and concentration of technetium Tc-99m sulfur colloid along with an injection of isosulfan blue dye.


RESULTS
Five patients had conjunctival melanoma, 6 had sebaceous cell carcinoma of the eyelid, and 2 had eyelid melanoma. SLN(s) were identified in all patients. In 12 patients, more than 1 SLN was identified. During surgery, no SLNs were blue. One patient with conjunctival melanoma had an SLN that was positive on histologic examination. There were no ocular or extraocular complications from the procedure except for mild temporary weakness of the marginal mandibular branch of the facial nerve in 2 patients that resolved completely within 4 to 6 weeks and without any further intervention. None of the patients had permanent blue tattooing of the conjunctival surface or eyelid skin.


CONCLUSIONS
Our experience suggests that lymphoscintigraphy and SLN biopsy with a small volume of technetium Tc-99m sulfur colloid and small incisions, even without the use of the blue dye, can identify SLNs in patients with conjunctival and eyelid malignancies, and can be performed safely.
Nijhawan
Navdeep
N
Section of Ophthalmology, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, U.S.A.
Ross
Merrick I
MI
Diba
Roxana
R
Ahmadi
M Amir
MA
Esmaeli
Bita
B
D018266:Adenocarcinoma, Sebaceous / Q000000981:diagnostic imaging* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D003230:Conjunctival Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005142:Eyelid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000556:secondary; D008875:Middle Aged; D011859:Radiography; D011877:Radionuclide Imaging; D012211:Rhenium; D012394:Rosaniline Dyes; D012626:Sebaceous Gland Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy; D013671:Technetium Tc 99m Sulfur Colloid
D004396:Coloring Agents; D012394:Rosaniline Dyes; C030406:technetium Tc rhenium-sulfur colloid; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium