title: Advantages of day-before lymphoscintigraphy and undiluted methylene blue dye injections for sentinel lymph node biopsies for melanoma.
abstract: OBJECTIVE
  Lymphatic mapping (LM) and blue dye injections are essential to identification of sentinel lymph nodes (SLN) for melanoma. LM is performed the day before (DB) or the same day (SD) of surgery, but the optimal timing is unknown. Similarly, methylene blue (MB), used during SLN biopsy (SLNB), is administered diluted (dMB) or undiluted (uMB), but the relative efficacies are unknown.
  
  
  METHODS
  Patients who underwent SLNB for melanoma from 2009 to 2013 at our institution were evaluated. Outcomes included operative correlation with LM, SLN identification, and postoperative complications.
  
  
  RESULTS
  One hundred seventy-one patients underwent SLNB. Sixty-seven (39%) had DB LM. Sixty-seven (39%) received uMB. Operative findings correlated with both LM groups, though the DB patients had lower background count (P = 0.018) and lower highest SLN radioactive signal count (P = 0.046). More uMB patients had blue SLNs (90% vs. 68%, P = 0.001). There was no difference in the total number of SLNs or complication rates in the LM and MB groups.
  
  
  CONCLUSIONS
  This is the first study to compare the use of DB LM with SD LM and the efficacy of uMB versus dMB. DB LM and uMB offer advantageous alternatives for patients and their surgeons without loss of accuracy or increased morbidity. J. Surg. Oncol. 2016;114:947-950. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Kate H
authors.initials: KH
authors.lastname: Dinh
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Ariana F
authors.initials: AF
authors.lastname: Harris
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: LaFemina
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Giles F
authors.initials: GF
authors.lastname: Whalen
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Mary
authors.initials: M
authors.lastname: Sullivan
authors.affiliation: Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Licho
authors.affiliation: Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hill
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lambert
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008751:Methylene Blue; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: lymphatic metastasis; radiometry; sentinel lymph node biopsy