Accuracy of the intra-operative radioauided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma

J. Kropp; A. Stein; I. Hackert; G. Sebastian; M. Meurer; T. Griming; K. Liepe; J. Pinkert; W.-G. Franke

doi:10.1055/s-0038-1623876

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2001; 40(03): 86-90
DOI: 10.1055/s-0038-1623876

Originalarbeiten – Original Articles

Schattauer GmbH

Accuracy of the intra-operative radioauided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma

Zuverlässigkeit der intraoperativen Lokalisation des Sentinel-Lymphknotens mittels Gammasonde 24 Stunden nach Lymphszintigraphie bei Patienten mit malignem Melanom

J. Kropp

¹Departments of Nuclear Medicine, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

A. Stein

²Departments of Dermatoloy, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

I. Hackert

²Departments of Dermatoloy, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

G. Sebastian

²Departments of Dermatoloy, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

M. Meurer

²Departments of Dermatoloy, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

T. Griming

¹Departments of Nuclear Medicine, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

K. Liepe

¹Departments of Nuclear Medicine, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

J. Pinkert

¹Departments of Nuclear Medicine, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

,

W.-G. Franke

¹Departments of Nuclear Medicine, University Hospital Carl Gustav Carus of the Technical University Dresden, Deutschland

› Author Affiliations

Abstract

Summary

Aim: For optimized logistics for the sentinel lymph-adenectomy (SL) it might be helpful for the clinics involved if a longer time period between the lymphoscintigraphy (LS) and surgery is possible. Therefore, we investigated if a precise localization of the sentinel lymph node is possible 24 hours after LS. Methods: 78 patients with primary malignant melanoma (MM; η = 44) or with MM pre-operated by excisional biopsy (n = 34) were investigated. In 40 cases the tumor was localized on the trunk and in 38 cases on the extremities. Mean MM thickness was 2.68 mm (range: 0.29 to 12 mm). In all patients a lymphoscintigraphy (LS) with an average of 85 MBq of Tc-99m nanocolloid was performed one day prior to surgery. Immediately after tracer application dynamic data acquisition was started at a LFOV gamma camera followed by a whole body scan. With a hand-held gamma detector (C-Trak^®) 2,4,6,8, and 24 hours after tracer administration the SLN was identified and the counts registered. Results: 94 SLNs were identified in 87 lymphatic basins from which 86 could be resected. Nine MM showed two draining channels. After 24 hours 15.5% (as an average) of the initial counts could be measured in the SLN. The uptake in the SLN in pre-operated versus patients with primary tumor was statistically not significant (p = 0.4). In 16 cases (20.5%) the SLN was tumor positive. Four of those patients developed distant metastases and two died within the first year. None of the patients with negative SLN developed distant metastases or died. Conclusion: The remaining activity in the SLN up to 24 hours after administration is sufficient for their intra operative localization. The method of lymphoscintigraphy and localization of the SLN by a hand-held gamma detector optimizes the intra operative identification of the SLN in patients with malignant melanoma.

Zusammenfassung

Ziel: Zur besseren Planung der Sentinel-Lymphadenekto-rnie (SL) wäre es für die beteiligten Kliniken hilfreich, wenn zwischen der Lymphszintigraphie (LS) und der Operation ein größerer Zeitraum verstreichen könnte. Wir untersuchten deshalb, ob bis zu 24 Stunden nach der LS vergehen können, ohne dass die präzise Lokalisierung des SLN darunter leidet. Methoden: 78 Patienten mit primärem (n = 44) oder mittels Exzisionsbiopsie voroperiertem (n = 34) malignem Melanom (MM) wurden untersucht. In 40 Fällen war der Tumor am Körper und in 38 Fällen an den Extremitäten lokalisiert. Die mittlere Dicke nach Breslow betrug 2,68 mm (Bereich 0,29 bis 12 mm). Bei allen Patienten wurde einen Tag vor der Operation eine Lymphabflussszintigraphie mit im Mittel 85 MBq Tc-99m-markiertem Nanokolloid durchgeführt. Unmittelbar nach der Tracerapplikation wurde eine dynamische Bildakquisition an einer Großfeld-Gammaka-mera gestartet, gefolgt von einer Ganzkörperaufnahme. Mittels einer Gamma-Handsonde (C-Trak^®) wurde 2, 4, 6, 8 und 24 Stunden nach der Radiopharmakaapplikation der Sentinel-Lymphknoten (SLN) identifiziert und die Counts gemessen. Ergebnisse: 94 SLNs wurden identifiziert in 87 drainierenden Bassins, von denen 86 reseziert werden konnten. Neun MMs wiesen zwei Drainage-wege auf. Nach 24 Stunden konnten im Mittel noch 15,5% der initialen Counts im SLN gemessen werden. Die Radioaktivitätsaufnahme in voroperierten Patienten gegenüber Patienten mit primärem MM war statistisch nicht signifikant unterschiedlich (p = 0,4). In 16 Fällen (20,5%) war der SLN Tumor positiv. Vier dieser Patienten entwickelten Fernmetastasen und zwei verstarben innerhalb des ersten Jahres. Keiner der Patienten mit unauffälligem SLN entwickelte Fernmetastasen im Nachbeobachtungsintervall. Schlussfolgerung: Die verbleibende Radioaktivität im SLN 24 Stunden nach der Lymphszintigraphie reicht für eine intraoperative Lokalisation aus. Die Methode der Lymphszintigraphie und der Lokalisation des SLN mit einer Gamma-Handsonde optimiert die Identifikation des SLN bei Patienten mit malignem Melanom.

Keywords

Melanoma - sentinel lymph node - gamma probe - lymphoscintigraphy - technetium nanocolloids

Schlüsselwörter

Melanom - Sentinel-Lymphknoten - Gammasonde - Lymphszintigraphie - Technetium Nanokolloide

Full Text

References

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