Hot dots – which nodes should be removed in sentinel lymph node biopsy for melanoma?

Abstract

Background

Sentinel lymph node biopsy (SLNB) is a critical staging tool for melanoma patients. The optimal number of lymph nodes removed in SLNB remains unclear. In this study, we retrospectively analysed and tested different criteria for selecting sentinel lymph nodes (SLNs) by radiotracer uptake and blue dye, and their impact on nodal staging. We also evaluated the association between SLN tumour burden and radiotracer uptake.

Methods

The study population consisted of melanoma patients undergoing SLNB. During the operation all radioactive and blue nodes were removed and sent for histopathological analysis. The ex vivo radioactive count and presence of blue dye of each node were recorded, and these were correlated with presence and size of metastasis in each SLN.

Results

Altogether 175 patients with clinically occult metastasis presented with one or more positive, i.e. metastatic, SLNs. The mean number of lymph nodes removed was 4.5, and the mean number of positive lymph nodes was 1.5 per patient. The most radioactive or hottest node was negative in 38 patients (22%). By removing the hottest node and all nodes with radioactivity >10% of the hottest node, 97% of patients would have been staged correctly. In five patients, metastasis was found solely in a SLN with radioactivity <10% of the hottest node. Of all 267 positive nodes removed, 125 (47%) contained blue dye. Patients with a negative hottest node were associated with lower SLN tumour burden.

Conclusions

By removing the hottest node and all nodes with radioactivity >10% of the hottest node, 97% of patients with SLN metastases are correctly staged with or without using blue dye.

Keywords:

• Melanoma
• sentinel lymph node biopsy
• radiotracer
• tumour burden

Disclosure statement

Each author declares having no financial conflicts of interest regarding the data presented in this manuscript. The Kurt and Doris Palander Foundation for Medical Research awarded the first author a scholarship. Apart from this, the funding for this article was from departmental sources only. Preliminary results have been presented in part at the Nordic Melanoma Meeting, Oslo, Norway, during 6–8 September 2012, and at the Joint International Oncology Congress, San Francisco, California, USA during 27–29 May 2013.

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.