Skip to main content
SpringerLink
Log in

Lymphoscintigraphy of melanoma: Lymphatic channel activity guides localization of sentinel lymph nodes, and gamma camera imaging/counting confirms presence of radiotracer in excised nodes

  • Original Articles
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Lymphescintigraphy has become a standard procperative procedure to map the cutaneous lymphatic channel for progression of nodal metastasis of melanoma of the skin. Lymphoscintigraphy was employed to visualize lymphatic channels as a guide to identify sentinel lymph nodes (SLNs). Excised tissue was imaged with a gamma camera to verify the findings of presurgical lymphoscintigraphy. Percent counts of SLN(s) among the total counts of the excised melanoma tumor or scar tissue and SLN(s) were calculated.

Methods

Eleven patients with cutaneous melanoma received four to ten intradermal injections of Tc-99m sulfur colloid at elual distances around the melanoma site. Images were made immediately after injection: 1 minute per image for 15 min; and then 5 minutes or 1,000,000 counts per image for 30 min. After surgery, the excised melanoma tumor or scar and SLN(s) were imaged/counted with a gamma camera. Percent counts of SLNs among the total counts of the excised melanoma tumor or scar tissue and SLNs were calculated. To validate the specimen count accuracy, an experimental phantom study was done.

Results

Linear lymphatic channels were identified between the injected sites and the SLNs in each patient. Gamma camera images demonstrated radioactivity in the SLNs of all patients, verifying the lymphoscintigraphy findings. Uptake in the SLNs of ten of the eleven patients ranged from 0.4 to 7.2% (mean 2.2%) of the total counts in excised tissue. We noted that a node with lower uptake should not be ignored because a lower percent of SLN activity does not necessarily rule out existing metastasis. In two of eleven patients, histopathologic showed metastases. One patient’s melanoma on the middle back had lymphatic channel activity directed to both axillae. The results of the phantom study validated accuracy of our specimen counts.

Conclusions

Because linear lymphatic channels existed between lymph nodes and the injected sites in all eleven patients, these lymphatic channels could be used as a guide for localizing SLNs. The SLNs indicated by presurgical lymphoscintigraphy were verified by postoperative gamma camera imaging, and radiotracer localization in the SLNs averaged 2.2%.

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

Similar content being viewed by others

References

  1. Uren RF, Howman-Giles R, Thompson JF, McCarthy WH. Exclusive lymphatic drainage from a melanoma on the back to intraabdominal lymph nodes.Clin Nucl Med 1998; 23: 71–73.

    Article  PubMed  CAS  Google Scholar 

  2. Vidal-Sicart S, Pons F, Piulachs J, Castel T, Palou J, Herranz R. Mid-arm sentinel lymph nodes showing surprising drainage from a malignant melanoma in the forearm.Clin Nucl Med 1998; 23: 273–274.

    Article  PubMed  CAS  Google Scholar 

  3. Uren RF, Howman-Giles RB, Thompson JF. Failure to detect drainage to the popliteal and epitrochlear lymph nodes on cutaneous lymphoscintigraphy in melanoma patients.J Nucl Med 1998; 39: 2195.

    PubMed  CAS  Google Scholar 

  4. Norman J, Cruse CW, Espinosa C, Cox C, Berman C, Clark R, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma.Am J Surg 1991; 162: 432–437.

    Article  PubMed  CAS  Google Scholar 

  5. Uren RF, Howman-Giles RB, Shaw HM, Thompson JF, McCarthy WH. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node.J Nucl Med 1993; 34: 1435–1440.

    PubMed  CAS  Google Scholar 

  6. 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: 392–399.

    PubMed  CAS  Google Scholar 

  7. Reintgen D, Cruse CW, Wells K, Berman C, Fenske N, Glass F, et al. The orderly progression of melanoma nodal metastases.Ann Surg 1994; 220: 759–767.

    Article  PubMed  CAS  Google Scholar 

  8. Albertini JJ, Cruse CW, Rapaport D, Wells K, Ross M, DeConti R, et al. Intraoperative radio-lymphoscintigraphy improves sentinel lymph node identification for patients with melanoma.Ann Surg 1996; 223: 217–224.

    Article  PubMed  CAS  Google Scholar 

  9. Alazraki NP, Eshima D, Eshima LA, Herda SC, Murray DR, Vansant JP, et al. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer and other potential cancer.Semin Nucl Med 1997; 27: 55–67.

    Article  PubMed  CAS  Google Scholar 

  10. Yudd AP, Kempf JS, Goydos JS, Stahl TJ, Feinstein RS. Use of sentinel node lymphoscintigraphy in malignant melanoma.RadioGraphics 1999; 19: 343–353.

    PubMed  CAS  Google Scholar 

  11. Baxter KG. Invited commentary (for Use of sentinel node lymphoscintigraphy in malignant melanoma).RadioGraphics 1999; 19: 354–356.

    Google Scholar 

  12. Eshima D, Eshima LA, Gotti NM, Herda SC, Algozine CA, Buvris TG, et al. Tc-99m-sulfur colloid for lymphoscintigraphy: Effects of preparation parameters.J Nucl Med 1996; 34: 1575–1578.

    Google Scholar 

  13. Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer.Ann Surg 1998; 227: 645–653.

    Article  PubMed  CAS  Google Scholar 

  14. Gulec SA, Moffat FL, Carroll RG, Serafini AN, Stakianahis GN, Allen L, et al. Sentinel lymph node localization in early breast cancer.J Nucl Med 1998; 39: 1388–1393.

    PubMed  CAS  Google Scholar 

  15. Bianchi C, Habib FA, Morita E, Leong SP. Identification of bilateral breast sentinel lymph nodes draining primary melanoma of the back by preoperative lymphoscintigraphy and intraoperative mapping.Clin Nucl Med 1999; 24: 501–503.

    Article  PubMed  CAS  Google Scholar 

  16. Brobeil A, Kamath D, Cruse CW, Rapaport DP, Wells KE, Shons AR, et al. The clinical relevance of sentinel lymph nodes identified with radiolymphoscintigraphy.J Fla Med Assoc 1997; 84: 157–160.

    PubMed  CAS  Google Scholar 

  17. Olmos RAV, Jansen L, Hoefnagel CA, Nieweg OE, Muller SH, Rutgers EJT, Kroon BR. Evaluation of mammary lymphoscintigraphy by a single intertumoral injection for sentinel node identification.J Nucl Med 2000; 41: 1500–1506.

    Google Scholar 

  18. Bedrosian I, Scheff AM, Mick R, Callans LS, Buchy LP, Spitz FR, et al. Tc-99m human serum albumin: an effective radiotracer for identifying sentinel lymph nodes in melanoma.J Nucl Med 1999; 40: 1143–1148.

    PubMed  CAS  Google Scholar 

  19. Shih WJ, DeLand FH, Domstad PA, Magoun S, Dillon ML. Open rib biopsy guided by radionuclide technique.Ann Thorac Surg 1984; 38: 59–62.

    Article  PubMed  CAS  Google Scholar 

  20. Alazaki N. Lymphoscintigraphy and the intraoperative gamma probe.J Nucl Med 1995; 36: 1780–1783.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine Service, Lexington Veterans Affairs Medical Center, 40511, Lexington, KY, USA

    Wei-Jen Shih M.D., Michael T. Hackett, U Yun Ryo, Becky Weizbinski, John J. Coupal & Sylvia Magoun

  2. Surgical Service, Lexington Veterans Affairs Medical Center, 40511, Lexington, KY, USA

    David A. Sloan

  3. Department of Diagnostic Radiology, University of Kentucky Medical Center, Lexington, Kentucky, USA

    Wei-Jen Shih M.D. & U Yun Ryo

  4. Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA

    David A. Sloan

Authors
  1. Wei-Jen Shih M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David A. Sloan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael T. Hackett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U Yun Ryo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Becky Weizbinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John J. Coupal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sylvia Magoun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei-Jen Shih M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shih, WJ., Sloan, D.A., Hackett, M.T. et al. Lymphoscintigraphy of melanoma: Lymphatic channel activity guides localization of sentinel lymph nodes, and gamma camera imaging/counting confirms presence of radiotracer in excised nodes. Ann Nucl Med 15, 1–11 (2001). https://doi.org/10.1007/BF03012124

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03012124

Key words

Search

Navigation