title: Usefulness of sentinel lymph node biopsy for the detection of metastasis in the early stage of extramammary Paget's disease.
abstract: BACKGROUND
  Invasive cases of extramammary Paget's disease have a poor prognosis, owing to its rapid progression and resistance to irradiation and chemotherapy. Morton et al. introduced a technique to identify sentinel lymph nodes by local injection of vital dyes and reported its benefit for managing the progress of malignant melanoma.
  
  
  OBJECTIVE
  Since the rate of lymph node metastasis of extramammary Paget's disease is not uncommon (reported from 8.5% to 26%), this study tested the hypothesis that sentinel lymph node biopsy would be useful to detect lymph node metastasis in the clinically early stage of extramammary Paget's disease.
  
  
  METHODS
  Eighteen patients with primary extramammary Paget's disease were enrolled in the study. The precise location of sentinel lymph nodes was visualized using either intraoperative patent blue dye injection or indocyanine green dye injection in combination with a hand-held gamma-detecting probe after a 99mTc phytate injection.
  
  
  RESULTS
  Of the 18 patients, sentinel lymph node metastasis was identified in 2 (Cases 2 and 15) of the 2 patients with deep invasion and in 1 (Case 12) of the 7 patients with minimal dermal invasion, however, it was absent in 9 patients who had been categorized into the intraepidermal group.
  
  
  CONCLUSIONS
  This study demonstrates that extramammary Paget's disease possibly causes metastasis via regional lymphatic systems to which the lesion belongs, even in the early stages of no nodule or tumor formation, and that sentinel lymph node biopsy is useful to detect lymph node metastasis.
authors.affiliation: Department of Dermatology.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kusatake
authors.affiliation: Department of Surgical Pathology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Harada
authors.affiliation: Department of Surgery, Shimane University, Ohda General Medicine Education Center, Ohda 694-0063, Shimane, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mizumoto
authors.affiliation: Department of Dermatology.
authors.forename: Sakae
authors.initials: S
authors.lastname: Kaneko
authors.affiliation: Department of Dermatology.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niihara
authors.affiliation: Department of Dermatology.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Chinuki
authors.affiliation: Department of Dermatology.
authors.forename: Eishin
authors.initials: E
authors.lastname: Morita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D004396:Coloring Agents; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology* / Q000601:surgery; D005834:Genital Neoplasms, Male / Q000473:pathology* / Q000601:surgery; D006119:Groin; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015609:Organotechnetium Compounds; D010145:Paget Disease, Extramammary / Q000556:secondary* / Q000601:surgery; D010833:Phytic Acid; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C026177:technetium phytate; D010833:Phytic Acid; C008769:sulfan blue; D007208:Indocyanine Green
keywords: carcinoembryonic antigen; extramammary Paget's disease; fluorescence imaging; metastasis; sentinel lymph node biopsy