Intraoperative identification of sentinel lymph node in patients with malignant melanoma

Abstract

Summary We report our experience with the technique of lymphatic mapping using patent blue V dye in patients with limb malignant melanoma. The technique is based on the hypothesis that embolic metastases occur along lymphatic channels to a 'sentinel' lymph node: the draining lymph node nearest the site of the primary malignant melanoma. Patent blue V dye (0.5-1.0 ml) is injected intradermally around the site of the melanoma. Immediately the groin or axilla is opened and the blue lymphatic channels followed to the sentinel node. The node is removed and examined by both haematoxylin and eosin (H&E) and immunohistochemical staining. We have carried out this technique in 35 patients, all of whom had 'clinically assessed' stage I disease. In all 35 patients, sentinel nodes were identified, and nine were found to contain unsuspected micrometastases. Our initial evaluation of intraoperative lymphatic mapping is very promising. The technique is practicable and easy to master. If 25% of patients with cutaneous malignant melanoma who are clinically stage I have nodal disease, this has great importance not only for staging and treatment but also for all future therapeutic trials.

Sentinel node detection in N0 cancer of the pharynx and larynx

“…British Journal of Cancer (2002) Paralell to other tumour entities there were intensified efforts within the last two decades, which are still discussed controversially, to limit the extent of lymph node dissection in the clinically staged N0 situations also for head and neck cancer patients. The aim of reducing a potential excess of surgical therapy for the patient is currently achieved quite successfully in other tumour entities by applying the so-called sentinel node (SN) concept (Lingam et al, 1997;De Cicco et al, 2000;Lantzsch et al, 2001). The extensive investigations on large patient cohorts in breast cancer and malignant melanoma are opposed by a comparative paucity of experience with the SN concept for SCC of the upper aerodigestive tract (Pitman et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Chiesa et al, 2000;Colnot et al, 2001;Stoeckli et al, 2001).…”

Lymphatic mapping and sentinel lymphadenectomy for melanoma

“…Elective LND or nodal observation is recommended for these patients. This emphasizes the importance of refer- [12] 106 129 N 96% 70% 84% 15% N/R N/A Leong et al [13] 163 189 N 98% 74% 98% 18% 18% N/A Lingam et al [14] 35 35 N 100% 100% N/A 26% 22% N/A Morton et al [15] 72 79 N 90% 90% N/A 15% N/R N/A Bostick et al [20] 87 100 N 97% 94% 94% 17% 24% N/A SN, sentinel node; NSN, non-sentinel node; N/A, not applicable; N/R, not reported. ring appropriate patients for SLND before proceeding with wide local excision.…”

Evidence-Based Principles in Pathology: Existing Problem Areas and the Development of “Quality” Practice Patterns

“…5,6 Tracer materials are injected into the tissue surrounding a primary tumor, and the lymph node with the highest concentration of the marker is labeled as the first one (the ''sentinel'') through which lymphatic fluid from a tumor site passes. 7 On the basis of that premise, one would conclude that an absence of neoplastic cells in the sentinel lymph node (SLN) should preclude their presence in the ''downstream'' (basin) lymph nodes and the viscera. 8 Prognostic and therapeutic value has been ascribed to this operation by surgeons, 4 and adjunctive technologies have been applied to the pathologic evaluation of SLNB specimens with the goal of detecting any and all neoplastic cells therein.…”