title: Management of sentinel lymph nodes in malignant skin tumors using dynamic lymphoscintigraphy and the single-photon-emission computed tomography/computed tomography combined system.
abstract: BACKGROUND
  The differentiation of true sentinel lymph nodes from nonsentinel lymph nodes is difficult in cases of multiple radiolabeled or dyed lymph nodes.
  
  
  METHODS
  We examined the locations of sentinel lymph nodes in melanoma and other malignant skin tumors by using dynamic lymphoscintigraphy and the single-photon-emission computed tomography/computed tomography (SPECT/CT) combined system.
  
  
  RESULTS
  Sentinel lymph nodes were detected in 45 of the 53 patients examined using only the ordinary blue dye method (85%), and were detected in all 35 patients examined using the SPECT/CT method (100%). Twenty of the 35 patients mentioned above had one sentinel lymph node. Multiple sentinel lymph nodes were demonstrated in the head and neck areas using the SPECT/CT method. Significant differences (P=0.0015) in the numbers of sentinel lymph nodes were found between the blue dye method only and the SPECT/CT method in the neck area. Popliteal sentinel lymph nodes were recognized in three patients, and cubital sentinel lymph nodes were recognized in two patients. Two patients had plural regional lymph nodes: one had popliteal and groin sentinel lymph nodes, while the other had cubital and axillary sentinel lymph nodes. The probe counts of the popliteus and cubitus were significantly lower (P=0.0241) than the counts in the groin, axilla, and neck areas. Micrometastatic sentinel lymph nodes were recognized in four patients, and two patients had metastases in both sentinel and nonsentinel lymph nodes.
  
  
  CONCLUSIONS
  Dynamic lymphoscintigraphy was useful when we were concerned about cubital and popliteal lymph nodes. The SPECT/CT combined system was useful in recognizing the anatomical location of sentinel lymph nodes before biopsy. The detection rate of sentinel lymph nodes using the SPECT/CT method was always better than that with the blue dye method (P=0.0197).
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan. ishihara@kaiju.medic.kumamoto-u.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ishihara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kaguchi
authors.forename: Shigeto
authors.initials: S
authors.lastname: Matsushita
authors.forename: Shinya
authors.initials: S
authors.lastname: Shiraishi
authors.forename: Seiji
authors.initials: S
authors.lastname: Tomiguchi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kageshita
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Ono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods*