Skip to main content
SpringerLink
Log in

Correlation between theoretical anatomical patterns of lymphatic drainage and lymphoscintigraphy findings during sentinel node detection in head and neck melanomas

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

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 %).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Forschner A, Eigentler TK, Pflugfelder A, Leiter U, Weide B, Held L, et al. Melanoma staging: facts and controversies. Clin Dermatol. 2010;28:275–80.

    Article  PubMed  Google Scholar 

  2. Thompson JF, Scolyer RA, Kefford RF. Cutaneous melanoma. Lancet. 2005;365:687–701.

    Article  CAS  PubMed  Google Scholar 

  3. Thompson JF, Uren RF. Lymphatic mapping in management of patients with primary cutaneous melanoma. Lancet Oncol. 2005;6:877–85.

    Article  PubMed  Google Scholar 

  4. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.

    Article  CAS  PubMed  Google Scholar 

  5. Balch CM, Morton DL, Gershenwald JE, McMasters KM, Nieweg OE, Powell B, et al. Sentinel node biopsy and standard of care for melanoma. J Am Acad Dermatol. 2009;60:872–5.

    Article  PubMed  Google Scholar 

  6. Krag DN, Meijer SJ, Weaver DL, Loggie BW, Harlow SP, Tanabe KK, et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg. 1995;130:654–8.

    Article  CAS  PubMed  Google Scholar 

  7. Thompson JF, McCarthy WH, Bosch CM, O'Brien CJ, Quinn MJ, Paramaesvaran S, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res. 1995;5:255–60.

    Article  CAS  PubMed  Google Scholar 

  8. Uren RF, Howman-Giles R, Thompson JF. Patterns of lymphatic drainage from the skin in patients with melanoma. J Nucl Med. 2003;44:570–82.

    PubMed  Google Scholar 

  9. Wilt JH, Thompson JF, Uren RF, Ka VS, Scolyer RA, McCarthy WH, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg. 2004;239:544–52.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Chakera AH, Hesse B, Burak Z, Ballinger JR, Britten A, Caracò C, et al. EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging. 2009;36:1713–42.

    Article  CAS  PubMed  Google Scholar 

  11. Willis AI, Ridge JA. Discordant lymphatic drainage patterns revealed by serial lymphoscintigraphy in cutaneous head and neck malignancies. Head Neck. 2007;29:979–85.

    Article  PubMed  Google Scholar 

  12. Ferlito A, Robbins KT, Shah JP, Medina JE, Silver CE, Al-Tamimi S, et al. Proposal for a rational classification of neck dissections. Head Neck. 2011;33:445–50.

  13. Rigual NR, Wiseman SM. Neck dissection: current concepts and future directions. Surg Oncol Clin N Am. 2004;13:151–66.

    Article  PubMed  Google Scholar 

  14. Reynolds HM, Smith NP, Uren RF, Thompson JF, Dunbar PR. Three-dimensional visualization of skin lymphatic drainage patterns of the head and neck. Head Neck. 2009;31:1316–25.

    Article  PubMed  Google Scholar 

  15. Reynolds HM, Dunbar PR, Uren RF, Thompson JF, Smith NP. Mapping melanoma lymphoscintigraphy data onto a 3D anatomically based model. Ann Biomed Eng. 2007;35:1444–57.

    Article  PubMed  Google Scholar 

  16. Vidal Sicart S, Brouwer OR, Valdes O. Evaluation of the sentinel lymph node combining SPECT/CT with the planar image and its importance for the surgical act. Rev Esp Med Nucl. 2011;5:331–7.

    Article  Google Scholar 

  17. Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22:209–12.

    Article  Google Scholar 

  18. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  19. O’Brien CJ, Petersen-Schaefer K, Ruark D, Coates AS, Menzie SJ, Harrison RI. Radical, modified, and selective neck dissection for cutaneous malignant melanoma. Head Neck. 1995;17(3):232–41.

    Article  PubMed  Google Scholar 

  20. Klop WM, Veenstra HJ, Vermeeren L, Nieweg OE, Balm AJ, Lohuis PJ. Assessment of lymphatic drainage patterns and implications for the extent of neck dissection in head and neck melanoma patients. J Surg Oncol. 2011;103:756–60.

    Article  PubMed  Google Scholar 

  21. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.

    Article  CAS  PubMed  Google Scholar 

  22. Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242:302–13.

    PubMed Central  PubMed  Google Scholar 

  23. Vidal M, Vidal-Sicart S, Torrents A, Perissinotti A, Navales I, Paredes P, et al. Accuracy and reproducibility of lymphoscintigraphy for sentinel node detection in patients with cutaneous melanoma. J Nucl Med. 2012;53:1193–9.

    Article  PubMed  Google Scholar 

  24. Uren RF, Howman-Giles R, Chung DK, Morton RL, Thompson JF. The reproducibility in routine clinical practice of sentinel lymph node identification by pre-operative lymphoscintigraphy in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14:899–905.

    Article  PubMed  Google Scholar 

  25. Fincher TR, O’Brien JC, McCarty TM, Fisher TL, Preskitt JT, Lieberman ZH, et al. Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2004;130:844–8.

    Article  PubMed  Google Scholar 

  26. Lin D, Franc BL, Kashani-Sabet M, Singer MI. Lymphatic drainage patterns of head and neck cutaneous melanoma observed on lymphoscintigraphy and sentinel lymph node biopsy. Head Neck. 2006;28:249–55.

    Article  PubMed  Google Scholar 

  27. De Rosa N, Lyman GH, Silbermins D, Valsecchi ME, Pruitt SK, Tyler DM, et al. Sentinel node biopsy for head and neck melanoma: a systematic review. Otolaryngol Head Neck Surg. 2011;145:375–82.

    Article  PubMed  Google Scholar 

  28. Veenstra HJ, Klop WM, Lohuis PJ, Nieweg OE, van Velthuysen ML, Balm AJ. Cadaver study on the location of suboccipital lymph nodes: guidance for suboccipital node dissection. Head Neck. 2014;36:682–6.

    Article  PubMed  Google Scholar 

  29. Veenstra HJ, Klop MW, Lohuis PJ, Nieweg OE, Valdés Olmos RA. Lymphatic drainage of melanomas located on the manubrium sterni to cervical lymph nodes: a case series assessed by SPECT/CT. Clin Nucl Med. 2013;38:137–9.

    Article  Google Scholar 

  30. Vermeeren L, Valdés Olmos RA, Klop WM, van der Ploeg IM, Nieweg OE, Balm AJ, et al. SPECT/CT for sentinel lymph node mapping in head and neck melanoma. Head Neck. 2011;33:1–6.

    Article  PubMed  Google Scholar 

  31. Reynolds HM, Dunbar PR, Uren RF, Blackett SA, Thompson JF, Smith NP. Three-dimensional visualization of lymphatic drainage patterns in patients with cutaneous melanoma. Lancet Oncol. 2007;8:806–12.

    Article  PubMed  Google Scholar 

  32. Leong SP, Morita ET, Südmeyer M, Chang J, Shen D, Achtem TA, et al. Heterogeneous patterns of lymphatic drainage to sentinel lymph nodes by primary melanoma from different anatomic sites. Clin Nucl Med. 2005;30:150–8.

    Article  PubMed  Google Scholar 

  33. Fairbairn N, Munson C, Khan ZA, Butterworth M. The role of hybrid SPECT/CT for lymphatic mapping in patients with melanoma. J Plast Reconstr Aesthet Surg. 2013;66:1248–55.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain

    Mónica Vidal, Sergi Vidal-Sicart, Diana Milena Ruiz, Pilar Paredes & Francesca Pons

  2. Institut d’Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Sergi Vidal-Sicart, Pilar Paredes & Francesca Pons

  3. Statistical of Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain

    Ferran Torres

  4. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    Ferran Torres

Authors
  1. Mónica Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergi Vidal-Sicart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferran Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diana Milena Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pilar Paredes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesca Pons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mónica Vidal.

Ethics declarations

Funding

This work was funded in part by an Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) grant. AGAUR 2014 SGR 279.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vidal, M., Vidal-Sicart, S., Torres, F. et al. Correlation between theoretical anatomical patterns of lymphatic drainage and lymphoscintigraphy findings during sentinel node detection in head and neck melanomas. Eur J Nucl Med Mol Imaging 43, 626–634 (2016). https://doi.org/10.1007/s00259-015-3256-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-015-3256-6

Keywords

Search

Navigation