Abstract
We have recently found that antimony (originating from the technetium 99m antimony trisulfide colloid, used for preoperative lymphoscintigraphy) can be measured in tissue sections from archival paraffin blocks of sentinel nodes (SNs) by means of inductively coupled plasma mass spectrometry (ICP-MS) to confirm that removed nodes are ture SNs. We performed a retrospective analysis of antimony concentrations in all our false-negative (FN) SNs to determine whether errors in lymphadenectomy (i.e., failure to remove true SNs) may be a cause of FN SN biopsies (SNBs). Among 27 patients with an FN SNB, metastases were found on histopathologic review of the original slides or additional sections in 7 of 23 patients for which they were available; however, antimony concentrations were low in 5 of 20 presumptive SNs. Our results suggest that an FN SNB can occur because of failure to remove the true SN as well as histopathologic misdiagnosis.
Similar content being viewed by others
References
Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience.Ann Surg Oncol 2000;7:469–74.
Clary BM, Brady MS, Lewis JJ, Coit DG. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence.Ann Surg 2001;233:250–8.
Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.J Clin Oncol 1999;17:976–83.
Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma.Br J Surg 2000;87:484–9.
Krag DN, Meijer SJ, Weaver DL, et al. Minimal-access surgery for staging of malignant melanoma.Arch Surg 1995;130:654–8.
Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group.Ann Surg 1999;230:453–63.
Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases.Ann Surg 1994;220:759–67.
Thompson JF, McCarthy WH, Bosch CM, 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.
Thompson JF. The Sydney Melanoma Unit experience of sentinel lymphadenectomy for melanoma.Ann Surg Oncol 2001;8:44S-7S.
Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17, 600 melanoma patients: validation of the American Joint Committee on cancer melanoma staging system.J Clin Oncol 2001;19:3622–34.
Clary BM, Mann B, Brady MS, et al. Early recurrence after lymphatic mapping and sentinel node biopsy in patients with primary extremity melanoma: a comparison with elective lymph node dissection.Ann Surg Oncol 2001;8:328–37.
Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma.J Clin Oncol 1998;16:2253–60.
Gadd MA, Cosimi AB, Yu J, et al. Outcome of patients with melanoma and histologically negative sentinel lymph nodes.Arch Surg 1999;134:381–7.
Harlow SP, Krag DN, Ashikaga T, et al. Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre study.Melanoma Res 2001;11:45–55.
Li L-XL, Scolyer RA, Ka VSK, et al. Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence: a clinicopathologic study of 1152 patients undergoing sentinel lymph node biopsy.Am J Surg Pathol 2003;27:1197–202.
Thompson JF. Sentinel node biopsy.J Surg Oncol 1997;66:270–2.
Thompson JF, Niewind P, Uren RF, et al. Single-dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patients.Melanoma Res 1997;7:500–6.
Cochran AJ. Surgical pathology remains pivotal in the evaluation of ‘sentinel’ lymph nodes.Am J Surg Pathol 1999;23:1169–72.
Cochran AJ. The pathologist's role in sentinel lymph node evaluation.Semin Nucl Med 2000;30:11–7.
Cochran AJ, Essner R, Rose DM, et al. Principles of sentinel lymph node identification: background and clinical implications.Langenbecks Arch Surg 2000;385:252–60.
Dawson M, Doble P, Beavis A, et al. Antimony by ICP-MS as a marker for sentinel lymph nodes in melanoma patients.Analyst 2003;128:217–9.
Uren RF, Howman-Giles R, Thompson JF, et al. Lymphoscintigraphy to identify sentinel lymph nodes in patients with melanoma.Melanoma Res 1994;4:395–9.
Essner R, Conforti A, Kelley MC, et al. Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma.Ann Surg Oncol 1999;6:442–9.
Statius Muller MG, Borgstein PJ, Pijpers R, et al. Reliability of the sentinel node procedure in melanoma patients: analysis of failures after long-term follow-up.Ann Surg Oncol 2000;7:461–8.
Haigh PI, Lucci A, Turner RR, et al. Carbon dye histologically confirms the identity of sentinel lymph nodes in cutaneous melanoma.Cancer 2001;92:535–41.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scolyer, R.A., Thompson, J.F., Li, LX.L. et al. Failure to remove true sentinel nodes can cause failure of the sentinel node biopsy technique: Evidence from antimony concentrations in false-negative sentinel nodes from melanoma patients. Annals of Surgical Oncology 11 (Suppl 3), 174S–178S (2004). https://doi.org/10.1007/BF02523624
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02523624