title: Sentinel Lymph Node Biopsy in Cutaneous Melanoma: Standard and New Technical Procedures and Clinical Advances. A Systematic Review of the Literature.
abstract: Melanoma is an important public health problem, and its incidence is increasing worldwide. The disease status of regional lymph nodes is the most important prognostic factor in early-stage melanoma patients. Sentinel lymph node biopsy (SLNB) was introduced in the early 1990s as a less invasive procedure than complete lymph node dissection to allow histopathologic evaluation of the "sentinel lymph node" (SLN), which is the first node along the lymphatic pathway from a primary tumor. Sentinel lymph node biopsy has minimal complication risks compared with standard complete lymph node dissection. Currently, SLNB is the accepted method for staging patients with clinically node-negative cutaneous melanoma and provides the most powerful prognostic information by evaluating the nodal basin status. The current practice of SLNB consists of the injection of Tc-labeled radiopharmaceutical, preoperative lymphoscintigraphy with the possibility of using the SPECT/CT hybrid imaging, and intraoperative SLN localization using a handheld gamma probe with or without the use of blue dye. Recently, the SLN localization and detection have been enhanced with the use of new tracers and new intraoperative devices, which have demonstrated to be particularly useful in melanomas of the head and neck region and in area of complex anatomy. Despite these important advances in the technology and the increasing experience in SLN mapping, major research centers have reported a false-negative rate higher than 15%. This relatively high false-negative rate, greater than those reported in the initial validation studies, points out the importance for the nuclear medicine community to continuously improve their knowledge on the biological behavior of melanoma and to improve the technical aspects that may allow more precise staging. For the SLNB procedure to be accurate, it is of critical importance that all "true" SLNs are identified and removed for examination. The aim of this article is to provide general information about the SLNB procedure in clinical practice highlighting the importance of standardization and accuracy of SLN identification in the light of the most recent technical innovations.
authors.affiliation: From the *Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa; †Department of Nuclear Medicine, Santa Maria della Misericordia Rovigo Hospital, Rovigo; ‡Nuclear Medicine Department, Sant'Andrea Hospital, La Spezia; §Department of Oncology, University Hospital of Pisa, Pisa, Italy; and ∥Department of Nuclear Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Elisa
authors.initials: E
authors.lastname: Tardelli
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzarri
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Marta
authors.initials: M
authors.lastname: Gennaro
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fantechi
authors.forename: Valerio
authors.initials: V
authors.lastname: Duce
authors.forename: Antonella
authors.initials: A
authors.lastname: Romanini
authors.forename: Sotirios
authors.initials: S
authors.lastname: Chondrogiannis
authors.forename: Duccio
authors.initials: D
authors.lastname: Volterrani
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Colletti
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manca
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D061305:Lymphoscintigraphy; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology*; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D000096142:Cutaneous Malignant Melanoma
chemical_list: D019275:Radiopharmaceuticals