The Impact of Lymphoscintigraphy Technique on the Outcome of Sentinel Node Biopsy in 1,313 Patients with Cutaneous Melanoma: An Italian Multicentric Study (SOLISM–IMI)

Journal of Nuclear Medicine

Carlo Riccardo Rossi¹  Giuseppe Giudice¹  Mauro Schiavon¹  Giorgio Landi¹  Dario Casara¹  Mirto Foletto¹  Giuseppe Ricotti¹  Giuseppe Macripò¹  Giuseppe Trifirò¹  Simone Mocellin¹  Federica Baldini¹  Gian Luca De Salvo¹  Franco Di Filippo¹  Maria Cristina Montesco¹  Paolo Carcoforo¹  Alessandro Testori¹  Davide Donner¹  Franco Picciotto¹ 

关键词: lymphoscintigraphy;    sentinel node biopsy;    cutaneous melanoma;    quality control program;   

DOI  :  

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

An observational multicentric Italian trial on sentinel node biopsy (SNB) in melanoma patients was performed to diffuse a common SNB protocol nationwide (Italy). We report herein the results of this trial. The influence of some technical aspects on the outcome of SNB was also investigated, because a certain degree of variability was accepted in performing lymphoscintigraphy. Methods: From January 2000 to December 2002, 1,313 consecutive patients with primary cutaneous melanoma (Breslow thickness, >1.0 mm or <1.0 mm but with ulceration, Clark level IV–V, presence of regression) were enrolled by 23 centers. One half to 1 mL of 99mTc-labeled human albumin colloid, at a suggested dosage of 5–15 or 30–70 MBq, was injected intradermally, closely around the scar, the same day or the day before SNB. Intraoperatively, Patent blue was associated when a definitive wide excision of the primary was required. A positive sentinel node (SN) was defined when containing melanoma cells detected by either hematoxylin–eosin or immunohistochemistry (S100 and HMB45 antibodies). All patients underwent regular follow-up. False-negative cases were considered when lymph node metastases occurred in the same lymphatic basin of SN biopsy (SNB) during follow-up. A quality control program has been performed for the surgical procedure and for the histologic diagnosis. Results: The SN identification rate was 99.3%. The axilla was the site of the SN in 52.5% of the cases. The mean number of SNs was 2.0 (range, 1–17) and only 1 node was removed in 45.4%. The positivity and false-negative rates were 16.9% and 14.7%, respectively (median follow-up, 31 mo). On multivariate analysis (logistic and linear regression) only the number of peritumor injections was inversely associated with the number of excised SNs (P = 0.002), whereas none of the technical variables showed an independent impact on SN status when Breslow thickness was included as a control variable. Conclusion: The number of peritumor injections seems to influence the outcome of lymphoscintigrapy in melanoma patients undergoing SNB. If these results are confirmed in a controlled trial, 3 injections at least should be recommended.

【 授权许可】

Unknown