Melanom

Melanoma. Results with the “sentinel node”

Summary

Since June 1995 we have practised a gamma probe guided sentinel lymphadenectomy (SLNE) in 274 patients after injecting a colloidal 99 m-Tc labelled solution around the tumor. By this technique the detection and excision of the SLN succeeded in 99.3 % of all cases. We found micrometastases in about 53.1 % of patients with pT3 and pT4 melanomas. The specimen of the radical lymph node dissection contained in 30 % further metastases. A regional recurrence after SLNE occurred only in one case, a SLN-negative patient.

Zusammenfassung

Seit Juni 1995 haben wir bei 274 Patienten ein Lymphatic Mapping mittels 99m-Tc markiertem Kolloid und anschließender Sentinel-Lymphadenektomie (SLNE) durchgeführt. Die Sentinel-Nachweisrate lag bei 99,3 %. Mikrometastasen ließen sich bei pT3- und pT4-Tumoren in 53,1 % nachweisen. Die radikale Lymphknotendissektion enthielt in 30 % weitere Lymphknotenmetastasen. Ein regionäres Rezidiv nach SLNE trat lediglich einmal - bei einem SLN-negativen Patienten - auf.

Key words

Sentinel lymph node - gamma probe - lymphatic mapping - malignant melanoma

Schlüsselwörter

Sentinel Lymphknoten - Gamma Probe - Lymphatic Mapping - malignes Melanom

Literatur

• 1 Alazraki N, Eshima D, Eshima L. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer and other potential cancers.  Sem Nucl Med. 1997;  27 55-67
• 2 Bachter D, Balda B R, Vogt H, Büchels H. Die „sentinel” Lymphonodektomie mittels Szintillationsdetektor.  Hautarzt. 1996;  47 754-758
• 3 Bachter D, Balda B R, Vogt H, Büchels H. Primary therapy of malignant melanomas: sentinel lymphadenectomy.  Int J Derm. 1998;  37 101-105
• 4 Balch C M. The role of elective lymph node dissection in melanoma: rationale, results and controversies.  J Clin Oncol. 1988;  6 163-172
• 5 Glass F L, Messina J L, Cruse W. The use of intraoperative radiolymphscintigraphy for sentinel node biopsy in patients with malignant melanoma.  Dermatol Surg. 1996;  22 715-720
• 6 Krag D N, Meijer S J, Weaver D L, Loggie B W. Minimal-access surgery for staging of malignant melanoma.  Arch Surg. 1995;  130 654-658
• 7 Morton D L, Wen D R, Wong J H. Technical details of intraoperative lymphatic mapping for early stage melanoma.  Arch Surg. 1992;  127 392-399
• 8 Pijpers R, Borgstein P J, Meijer S, Hoeckstra O S. Sentinel node biopsy in melanoma patients: dynamic lymphoscintigraphy followed by intraoperative gamma probe and vital dye guidance.  World J Surg. 1997;  21 788-793
• 9 Sim F H, Taylor W F, Pritchard D J, Soule E. Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study.  Mayo Clin Proc. 1986;  61 697-705
• 10 Veen van der H, Hoekstra O S, Paul M A, Cuesta M A, Meijer S. Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy.  Br J Surg. 1994;  81 1769-1770
• 11 Veronesi U, Adamus J, Bandiera D C. Inefficacy of immediate node dissection in stage I melanoma of the limbs.  N Engl J Med. 1977;  297 627-630