Annals of Surgical Oncology

, Volume 18, Issue 10, pp 2919–2924

Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye

  • Liang-Chih Liu
  • Brian M. Parrett
  • Tyler Jenkins
  • Wayne Lee
  • Eugene Morita
  • Patrick Treseler
  • Laura Huang
  • Suresh Thummala
  • Robert E. Allen
  • Mohammed Kashani-Sabet
  • Stanley P. L. Leong
Melanomas

DOI: 10.1245/s10434-011-1689-0

Cite this article as:
Liu, L., Parrett, B.M., Jenkins, T. et al. Ann Surg Oncol (2011) 18: 2919. doi:10.1245/s10434-011-1689-0

Abstract

Background

Determining how many sentinel lymph nodes (SLNs) should be removed for melanoma is important. The purpose of this study is to determine the frequency at which nodes that are less radioactive than the “hottest” node (which is negative) are positive for melanoma, how low of a radioactivity should warrant harvest, and if isosulfan blue is necessary.

Methods

We reviewed 1,152 melanoma patients who underwent lymphoscintigraphy with technetium, with or without blue dye, and SLN dissection from 1996 to 2008. SLNs with radioactivity ≥10% of the “hottest” SLN, all blue nodes, and all suspicious nodes were removed and analyzed. The miss rate was calculated as the proportion of node positive cases in which the “hottest” SLN was negative.

Results

SLNs were identified in 1,520 nodal basins in 1,152 patients. SLN micrometastases were detected in 218 basins (14%) in 204 patients (18%). In 16% of SLN-positive patients (33/204 patients), the positive SLN was found to have a lower radioactive count than the “hottest” SLN, which was negative. In 21 of these cases, the positive SLNs had radioactivity ≤50% of the “hottest” SLN. The 10% rule significantly reduced the miss rate to 2.5% compared with removal of only the “hottest” SLN (miss rate = 16%). Also, blue dye did not significantly decrease the miss rate compared with radiocolloid alone using the 10% rule.

Conclusions

To decrease the miss rate, all SLNs with ≥10% of the ex vivo radioactivity of the “hottest” SLN should be removed and blue dye is not essential.

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Liang-Chih Liu
    • 1
  • Brian M. Parrett
    • 2
  • Tyler Jenkins
    • 1
  • Wayne Lee
    • 1
  • Eugene Morita
    • 3
  • Patrick Treseler
    • 4
  • Laura Huang
    • 1
  • Suresh Thummala
    • 5
    • 6
  • Robert E. Allen
    • 1
  • Mohammed Kashani-Sabet
    • 5
    • 6
  • Stanley P. L. Leong
    • 1
    • 6
  1. 1.Department of SurgeryUniversity of CaliforniaSan FranciscoUSA
  2. 2.The Buncke Clinic, Division of Plastic SurgeryCalifornia Pacific Medical CenterSan FranciscoUSA
  3. 3.Department of Nuclear MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.Department of PathologyUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of DermatologyUniversity of CaliforniaSan FranciscoUSA
  6. 6.Center for Melanoma Research & Treatment, California Pacific Medical Center & Research InstituteSan FranciscoUSA