Summary
Background
Preoperative lymphoscintigraphy for sentinel node biopsy (SNB) combined with intra-operative
gamma-probe detection often identifies nodes within the pelvis. This study investigates
the role of pelvic SNB harvest.
Methods
Retrospective review of eighty-two stage I/II melanoma patients with primary tumour
on the lower limb and trunk who underwent groin SNB, either inguinal or pelvic or
both, over a three year period.
Results
Of the 82 patients, 19 had positive SNBs (24%), all of which were inguinal nodes.
None of the 11 patients with pelvic nodes removed had a positive pelvic node. The
median follow-up period was 18 months (SD: 10.8; range: 8–43). Although the complication
rate was higher following pelvic SNB, the difference was not statistically significant
(p > 0.5). The average operative time for an inguinal SNB was 92 min, and increased
significantly to 134 min for a pelvic SNB (p < 0.0001). Lymphoscintigraphy of trunk and thigh melanomas identified individual
tracks to be leading directly from the tumour to a pelvic node(s). However, when the
primary tumour was located at or below the knee, pelvic nodes identified by lymphoscintigraphy
appeared to be second level nodes.
Conclusion
A lymphoscintigraphy protocol that includes dynamic images obtained in frequent intervals
following injection of the radiotracer combined with thorough preoperative analysis
of the lymphoscintigraphy scans and effective communication between the radiologist
and the surgeon allows accurate identification of the primary tracks and prevent unnecessary
harvest of second echelon pelvic lymph nodes. In patients with significant co-morbidities
due consideration is required before harvesting pelvic sentinel nodes.
Keywords
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Article info
Publication history
Published online: September 22, 2011
Accepted:
August 11,
2011
Received:
August 6,
2011
Footnotes
☆Meetings At Which The Work Was Presented: 1. The 7th International Sentinel Node Society Meeting, November 2010, Pacifico Yokohama, Japan. 2. British Association of Plastic Reconstructive and Aesthetic Surgeons, Winter Scientific Meeting, December 2010, London, United Kingdom. 3. St. Joseph Mercy Hospital 17th Annual Research Forum, April 2011, Ann Arbor, Michigan, United States.
Identification
Copyright
Published by Elsevier Inc.
