Lymphoscintigraphy and sentinel nodes.
It has been validated that sentinel lymph node biopsy (SLNB) shows whether a patient's breast cancer or melanoma has spread to regional lymph nodes. As a result, management of patients with these cancers has been revolutionized. SLNB has replaced axillary lymph node dissection (ALND) as the staging modality of choice for early breast cancer and has replaced complete lymph node dissection as the staging modality of choice for melanoma in patients whose SLNBs indicate no metastases. Recently concluded multicenter, randomized trials for breast cancer with 5- to 10-y outcome data have shown no significant differences in disease-free survival rates or overall survival rates between SLNB and ALND groups but have shown significantly lower morbidity with SLNB than with ALND. The lowest false-negative rates (5.5%-6.7%) were seen in studies that used preoperative lymphoscintigraphy and dual mapping during surgery. To assess the survival impact of SLNB in melanoma, the Multicenter Selective Lymphadenectomy Trial I was performed. Melanoma-specific survival rates were not different between subjects randomized to SLNB with lymphadenectomy for nodal metastasis on biopsy and subjects randomized to observation with lymphadenectomy for nodal relapse. However, the 10-y disease-free survival rates were better for the SLNB group than for the observation group, specifically among patients with intermediate-thickness melanomas or thick melanomas.
Emory University School of Medicine, Atlanta, Georgia; and vmoncay@emory.edu.
Valeria M
VM
Moncayo
Emory University School of Medicine, Atlanta, Georgia; and VA Medical Center, Atlanta, Georgia.
John N
JN
Aarsvold
Emory University School of Medicine, Atlanta, Georgia; and VA Medical Center, Atlanta, Georgia.
Naomi P
NP
Alazraki
D000328:Adult; D000368:Aged; D001706:Biopsy; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging; D013667:Technetium / Q000737:chemistry*
D013667:Technetium
breast cancer; lymphoscintigraphy; melanoma; sentinel lymph node