Lymphoscintigraphy in Malignant Melanoma and Breast Cancer

Can lymphatic drainage of head and neck melanoma be predicted?

“…Staging of the regional lymph basin with SLN biopsy is aided by lymphoscintigraphy. Lymphoscintigraphy demonstrates the lymphatic flow from the primary melanoma to the regional lymph node basin of the H&N, as well as other body sites as documented in numerous studies 9, 12, 19, 21–25. Early studies using lymphoscintigraphy for H&N melanoma reported a change in surgical approach in 33–73% of the cases thereby improving the accuracy and reducing the morbidity of complete lymph node dissection 9, 22, 26, 27.…”

The Role of Lymphoscintigraphy in the Management of the Patient With Breast Cancer

“…Lymphoscintigraphy then requires dynamic studies with associated lymph-vessel depiction and sustained lymph-node retention. 5,10,11 Although it has been suggested that mammary lymphoscintigraphy increases the accuracy of the SLN procedure by distinguishing between the first and second tier nodes and by detection of lymphatic routes outside the axilla, in some cases, lymph nodes are not discernible. 5 In addition, the demonstration of extra-axillary lymphatic drainage only becomes important when a treatment decision is to be made based on the finding.…”

“…Particles larger than 100 nm usually become trapped in interstitial space and never enter the lymphatic system. 10,19 Animal studies have suggested that optimal lymph node uptake of colloids should be achieved with particle sizes between 10 and 50 nm. 20 Historically, investigators have preferred antimony trisulfide colloid for lymphoscintigraphic studies because its particle size, 3-30 nm, is optimal for transit through lymphatics and localization in nodes without phagocytosis.…”

“…Injection into the tumor or seroma cavity will result in no or little migration of radiopharmaceutical to the SLN. 10 Localization wires must be avoided as well as the technique of injection through the needle through which the localization wire was passed because it acts as a wick causing some of the dose to taint the skin sur-face. 9 -12 This reduces the dose available for imaging and produces confounding contamination of the skin surface.…”