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Reliability of lymphoscintigraphy in indicating the number of sentinel nodes in melanoma patients

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Abstract

Background: This study was undertaken to establish the reliability of lymphoscintigraphy in indicating the number of sentinel nodes in patients with melanoma.

Methods: Lymphoscintigraphy was performed with dynamic imaging after injection of 60 MBq99mTc-nanocolloid (1.6 mCi) and static imaging after 2 hours in 200 patients with clinically localized primary melanoma of the skin. The following day, sentinel nodes were retrieved with the blue dye technique and a gamma detection probe (Neoprobe 1000/1500). The discrepancies between the number of sentinel nodes indicated by lymphoscintigraphy and the actual number of sentinel nodes as established by the surgeon were evaluated.

Results: Lymphoscintigraphy showed drainage to 393 sentinel nodes in 255 lymphatic fields in 199 patients. In 48 lymphatic fields (19%) in 46 patients (23%), the number of sentinel nodes was different from the number that was visualized with scintigraphy. Additional sentinel nodes were found by the surgeon because a lymphatic vessel was not seen on the lymphoscintigraphy (43%), because a sentinel node was not visualized separately from other hot nodes or vessels or the injection site (36%), or because a sentinel node was blue and not hot (4%). Fewer sentinel nodes were found than suggested by scintigraphy because a lymphangioma was mistaken for a sentinel node (4%) or because a single elongated node was depicted as two hot spots (6%).

Conclusions: Although lymphoscintigraphy is indispensable for lymphatic mapping, the predicted number of sentinel nodes is accurate in only 81% of lymph node fields. The limited discriminating power of the gamma camera is an important cause of discrepancies.

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Authors and Affiliations

  1. From the Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Liesbeth Jansen MD, PhD, Omgo E. Nieweg MD, PhD, B. Acca E. Kapteijn MD, PhD & Bin B. R. Kroon MD, PhD

  2. Department of Nuclear Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Renato A. Valdés Olmos MD, PhD, Sara H. Muller PhD & Cornelis A. Hoefnagel MD, PhD

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  1. Liesbeth Jansen MD, PhD
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  2. Omgo E. Nieweg MD, PhD
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  3. B. Acca E. Kapteijn MD, PhD
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  4. Renato A. Valdés Olmos MD, PhD
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  5. Sara H. Muller PhD
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  6. Cornelis A. Hoefnagel MD, PhD
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  7. Bin B. R. Kroon MD, PhD
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Correspondence to Liesbeth Jansen MD, PhD.

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Jansen, L., Nieweg, O.E., Kapteijn, B.A.E. et al. Reliability of lymphoscintigraphy in indicating the number of sentinel nodes in melanoma patients. Ann Surg Oncol 7, 624–630 (2000). https://doi.org/10.1007/BF02725343

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  • DOI: https://doi.org/10.1007/BF02725343

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