[Intraoperative labeling of sentinel lymph nodes with a combination of vital dye and radionuclide tracer--results in sentinel lymph node-positive patients].
BACKGROUND
Sentinel lymph node biopsy enhances the accuracy of tumor staging in patients with malignant melanoma and can help select candidates for regional lymphadenectomy. There are two techniques for identifying the sentinel lymph node: intradermal injection of a radionuclide tracer or of a blue dye. We evaluated both methods to determine how they can be best utilized to locate a sentinel lymph node.


METHODS
In a retrospective study, 323 patients with melanoma (tumor thickness > or = 0.75 mm) who underwent sentinel lymph node biopsy after both radionuclide and blue dye injection were evaluated. The labeling of lymph nodes showing micrometastasis by histopathological examination was determined.


RESULTS
63 patients showed sentinel lymph nodes with micrometastasis. All of these nodes (100 %) were labeled with radionuclide tracer, but only 90 % with blue dye. In 5 patients, only radionuclide labeling identified the histopathologically-positive lymph node. In 36 patients, several sentinel lymph nodes were identified, with the histopathologically-positive nodes usually showing a higher radioactive signal intensity than the negative ones.


CONCLUSIONS
Since in some patients histopathologically-positive lymph nodes are only labeled by radionuclide tracer, radionuclide labeling is indispensable for locating sentinel lymph nodes. In contrast, labeling with blue dye represents a supplementary method, which can simplify the recognition of the sentinel lymph node during surgery.
Pfützner
Wolfgang
W
Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München. Wolfgang_Pfutzner@web.de
Kunte
Christian
C
Weiss
Mayo
M
Flaig
Michael I
MI
Konz
Birger
B
D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery
D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C008769:sulfan blue