Annals of Surgical Oncology

, Volume 9, Issue 9, pp 929–933 | Cite as

The definition of the sentinel lymph node in melanoma based on radioactive counts

  • Grant W. Carlson
  • Douglas R. Murray
  • Vinod Thourani
  • Andrea Hestley
  • Cynthia Cohen
Original Articles



There is no consensus on the definition of a hot, nonblue sentinel lymph node (SLN), despite the widespread use of radiocolloid in SLN mapping.


A retrospective review of 592 patients with malignant melanoma who underwent SLN mapping was performed. Ex vivo SLN counts and nodal bed counts were obtained by using a gamma probe. The size of each metastatic deposit in an SLN was defined as macrometastases (>2 mm), micrometastases (≤2 mm), a cluster of cells, or isolated melanoma cells.


A total of 1175 SLNs (SLN, n=1041; SLN+, n=134) were evaluated. The mean SLN count/bed counts were SLN, 322±980 and SLN+, 450±910 (not significant [NS]) (>2 mm, 270±792 [NS]; ≤2 mm, 446±693 [NS]; isolated melanoma cells/cluster of cells, 677±1189 [P=.036]). Overall, 16 (1.4%) of the SLNs collected had an overall ratio of ≤2. This included two positive SLNs (1.5%), both of which contained macrometatic disease. Forty-seven positive nodal basins had at least one negative SLN. The hottest SLNs in these basins were negative for metastatic disease in nine cases (19.1%). In one basin (2.1%), the positive SLN count was <10% of the hottest lymph node count.


Removal of lymph nodes until the bed count is 10% of the hottest lymph node will remove 98% of positive SLNs. Lymph node tumor burden influences radioactive counts.

Key Words

Melanoma Sentinel lymph node Radioactive counts Lymph node basin 


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  1. 1.
    Morton DL, Wen DR, Wong JH, et al.. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.PubMedGoogle Scholar
  2. 2.
    Morton DL, Bostick PJ. Will the true sentinel node please stand?Ann Surg Oncol 1999;6:12–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Kapteijn BA, Nieweg OE, Muller SH, et al. Validation of gamma probe detection of the sentinel node in melanoma.J Nucl Med 1997;38:362–6.PubMedGoogle Scholar
  4. 4.
    Albertini JJ, Cruse CW, Rapaport D et al. Intraoperative radiolympho-scintigraphy improves sentinel lymph node identification for patients with melanoma.Ann Surg 1996;223:217–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Alex JC, Weaver DL, Fairbank JT, Rankin BS, Krag DN. Gammaprobe-guided lymph node localization in malignant melanoma.Surg Oncol 1993;2:303–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Brobeil A, Kamath D, Cruse CW et al. The clinical relevance of sentinel lymph nodes identified with radiolymphoscintigraphy.J Fla Med Assoc 1997;84:157–60.PubMedGoogle Scholar
  7. 7.
    Glass LF, Messina JL, Cruse W, et al. The use of intraoperative radiolymphoscintigraphy for sentinel node biopsy in patients with malignant melanoma.Dermatol Surg 1996;22:715–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Bostick P, Essner R, Sarantou T, et al. Intraoperative lymphatic mapping for early-stage melanoma of the head and neck.Am J Surg 1997;174:536–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Murray DR, Carlson GW, Greenlee R, et al. Surgical management of malignant melanoma using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy: the Emory experience.Am Surg 2002;66:763–7.Google Scholar
  10. 10.
    Dowlatshahi K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma.Cancer 1997;80:1188–97.PubMedCrossRefGoogle Scholar
  11. 11.
    Hermanek P, Hutter RV, Sobin LH, Wittekind C. International Union Against Cancer. Classification of isolated tumor cells and micrometastasis.Cancer 1999;86:2668–73.PubMedCrossRefGoogle Scholar
  12. 12.
    McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed?Ann Surg Oncol 2001;8:192–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Carlson GW, Murray DR, Greenlee R, et al. Management of malignant melanoma of the head and neck using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy.Arch Otolaryngol Head Neck Surg 2000;126:433–7.PubMedGoogle Scholar
  14. 14.
    Bostick P, Essner R, Glass E, et al. Comparison of blue dye and probe-assisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins.Arch Surg 1999;134:43–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Faries MB, Bedrosian I, Reynolds C, Nguyen HQ, Alavi A, Czerniecki BJ. Active macromolecule uptake by lymph node antigen-presenting cells: a novel mechanism in determining sentinel lymph node status.Ann Surg Oncol 2000;7:98–105.PubMedCrossRefGoogle Scholar
  16. 16.
    Hill AD, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer.Ann Surg 1999;229:528–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Essner R, Bostick PJ, Glass EC, et al. Standardized probe-directed sentinel node dissection in melanoma.Surgery 2000;127:26–31.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 2002

Authors and Affiliations

  • Grant W. Carlson
    • 1
    • 2
  • Douglas R. Murray
    • 1
    • 2
  • Vinod Thourani
    • 1
    • 2
  • Andrea Hestley
    • 1
    • 2
  • Cynthia Cohen
    • 1
    • 2
  1. 1.Department of SurgeryEmory University School of MedicineAtlanta
  2. 2.Department of PathologyEmory University School of MedicineAtlanta

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