title: Correlation between theoretical anatomical patterns of lymphatic drainage and lymphoscintigraphy findings during sentinel node detection in head and neck melanomas.
abstract: OBJECTIVE
  In the diagnosis of head and neck melanoma, lymphatic drainage is complex and highly variable. As regional lymph node metastasis is one of the most important prognostic factors, lymphoscintigraphy can help map individual drainage patterns. The aim of this study was to compare the results of lymphoscintigraphy and sentinel lymph node (SLN) detection with theoretical anatomical patterns of lymphatic drainage based on the location of the primary tumour lesion in patients with head and neck melanoma. We also determined the percentage of discrepancies between our lymphoscintigraphy and the theoretical location of nodal drainage predicted by a large lymphoscintigraphic database, in order to explain recurrence and false-negative SLN biopsies.
  
  
  METHODS
  In this retrospective study of 152 patients with head and neck melanoma, the locations of the SLNs on lymphoscintigraphy and detected intraoperatively were compared with the lymphatic drainage predicted by on-line software based on a large melanoma database.
  
  
  RESULTS
  All patients showed lymphatic drainage and in all patients at least one SLN was identified by lymphoscintigraphy. Of the 152 patients, 4 had a primary lesion in areas that were not described in the Sydney Melanoma Unit database, so agreement could only be evaluated in 148 patients. Agreement between lymphoscintigraphic findings and the theoretical lymphatic drainage predicted by the software was completely concordant in 119 of the 148 patients (80.4 %, 95 % CI 73.3 - 86 %). However, this concordance was partial (some concordant nodes and others not) in 18 patients (12.2 %, 95 % CI 7.8 - 18.4 %). Discordance was complete in 11 patients (7.4 %, 95 % CI 4.2 - 12.8 %).
  
  
  CONCLUSIONS
  In melanoma of the head and neck there is a high correlation between lymphatic drainage found by lymphoscintigraphy and the predicted drainage pattern and basins provided by a large reference database. Due to unpredictable drainage, preoperative lymphoscintigraphy is essential to accurately detect the SLNs in head and neck melanoma.
authors.affiliation: Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain. monicavidalg@hotmail.com.
authors.forename: Mónica
authors.identifier: http://orcid.org/0000-0003-2003-7954
authors.initials: M
authors.lastname: Vidal
authors.affiliation: Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Vidal-Sicart
authors.affiliation: Statistical of Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain.|Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Torres
authors.affiliation: Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Diana Milena
authors.initials: DM
authors.lastname: Ruiz
authors.affiliation: Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Paredes
authors.affiliation: Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pons
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy
keywords: Lymphoscintigraphy; Melanoma, head and neck; Sentinel lymph node