Role of lymphoscintigraphy and sentinel lymph node biopsy in the management of pediatric melanoma and sarcoma

Abstract

Purpose The purpose of this study was to describe the use of lymphoscintigraphy and sentinel lymph node biopsy for the management of children with melanoma and sarcomas. We report the experience of two children’s hospitals that utilize this technique to identify sentinel lymph nodes for lymph node biopsy and dissection. Methods We identified 56 patients (median age 10.8 years) who underwent 58 lymphoscintigraphy procedures. There were 33 patients with melanoma and melanocytic lesions, and 23 with sarcomas. Results Of 58 lymphoscintigraphy procedures, sentinel lymph nodes were identified in 52 (90% success rate). Using the combination of intraoperative blue dye injection and lymphoscintigraphy, the success rate was 95% (55/58). Metastatic disease was found in 14 sentinel lymph nodes (13 patients with melanoma and melanocytic lesions, and 1 patient with rhabdomyosarcoma). Conclusion We have found that lymphoscintigraphy with sentinel lymph node biopsy is an effective method to identify patients who may benefit from more extensive lymph node dissection and to identify those patients who are unlikely to benefit from further lymph node exploration.

Application of nuclear medicine to achieve less invasive surgery for malignant solid tumors in children

“…reported that they achieved a feasibly high success rate (95%) to identify SN in patients with melanoma or sarcoma using combination of preoperative lymphoscintigraphy and intraoperative mapping (blue dye/gamma probe), which we performed in our current study. They also found the SN metastasis in one RMS patient out of six cases (16.7%) who underwent lymphoscintigraphy/SLNB whereas no SN metastasis was observed in patients with non‐RMS sarcomas (0/17) . Those findings were consistent with results from previous reports with 11.1–33.3% SN positivity rate for RMS patients …”

“…Several papers have been published to demonstrate SLNB on a variety of childhood malignancies, such as melanomas, RMS, non‐RMS soft tissue sarcomas and breast cancers . Parida et al . reported that they achieved a feasibly high success rate (95%) to identify SN in patients with melanoma or sarcoma using combination of preoperative lymphoscintigraphy and intraoperative mapping (blue dye/gamma probe), which we performed in our current study.…”

“…It should be noted that this hypothesis has been rarely proven within a number of previous reports in which children with extremity RMS were enrolled. As discussed above, lymphoscintigraphy/SLNB detected SN metastasis in one out of three to nine RMS patients; however, none of them underwent a subsequent regional lymph‐node dissection, but they received additional radiation therapy to the regional lymph‐node basin . Therefore, the false positive rate of this procedure has not been evaluated properly.…”

“…This technique has recently been accepted as standard practice for staging newly diagnosed and clinically non‐metastatic malignant melanoma and breast cancers, as postoperative complications are significantly less likely to occur compared with extensive lymphadenectomy . However, only a few papers have described SLNB for malignant tumors in children …”

Detection of lymph node metastases in pediatric and adolescent/young adult sarcoma: Sentinel lymph node biopsy versus fludeoxyglucose positron emission tomography imaging—A prospective trial

“…Sentinel lymph node biopsy (SLNB) was designed as a rational alternative to random sampling with the hypothesis that the first (sentinel) node to receive lymphatic drainage from a tumor site would be most likely to contain metastatic tumor. SLNB is widely used for cancers such as melanoma and breast cancer, and it has been used safely in pediatric melanoma and sarcoma . SLNB is performed via the injection of a technetium‐99m–labeled colloid tracer and lymphazurin blue dye at the tumor site.…”