Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

Abstract

In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.

Transcutaneous sentinel lymph node detection in cutaneous melanoma with indocyanine green and near-infrared fluorescence: A diagnostic sensitivity study

“…[11,26] It is under this assumption that our results regarding number of identified LNs must be interpreted, thus relativizing the seemingly reduced sensitivity of ICG based on the number of LNs identified transcutaneously in comparison to LS (79.4% sensitivity). However, as Cirocchi et al [27] described in their study, trunk malignant melanoma (especially lumbar, scapular, and subscapular) have a heterogenous drainage pattern, meaning that they can drain in multiple and/or bilateral nodal basins. In our study, ICG was able to identify in 4 patients with trunk malignant melanoma additional nodal basins.…”

Preliminary Study of Axillary Lymphatic Drainage in Cutaneous Melanoma Patients: A Cross-Sectional Study

“…The data we obtained underline how cutaneous melanoma presents an extremely heterogenous lymphatic drainage at the level of the axillary cavity. A previous study by Cirocchi et al [ 28 ] had shown how the lymphatic drainage of cutaneous melanoma is extremely heterogenous: it is more various if compared to the topographic localization of the lymph nodes at the level of the axillary cavity.…”

Fluorescent‐guided surgery and the use of indocyanine green sentinel lymph node mapping in the pediatric and young adult oncology population

“…Since then, its off‐label use has been broadened and rapidly expanding, where it has been described in intravascular organ perfusion, hepatic clearance, pulmonary imaging, ureter identification, and lymphatic imaging. Its use for mapping of sentinel lymph nodes has been described in adult malignancies including melanoma, 20,21 breast, 22–26 endometrial, 27,28 colorectal, 29–33 pulmonary, 34,35 and gastric cancer 36,37 . These studies have looked at application of ICG in the adult population, but similar studies are lacking in pediatric surgical oncology.…”