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Sentinel node biopsy for melanoma: a study of 241 patients

Chakera, Annette Hougaarda; Drzewiecki, Krzysztof Tadeusza; Eigtved, Annikab; Juhl, Birgitte Ravnc

ORIGINAL ARTICLES
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The aim of this study was to evaluate the sentinel node biopsy (SNB) technique for melanoma using both radiocolloid and blue dye in 241 clinically N0 patients with melanomas >1.0 mm, or thinner lesions exhibiting regression/ulceration. We showed that an increase in injected radioactivity increased both the number of visualized nodes at lymphoscintigraphy and the number of SNs removed surgically. At least one SN was removed in 98% (236) of patients, and all nodes were identified with the probe. Seventy-four per cent of the 194 patients injected with blue dye had stained SNs. In 46% (144) of the lymph node basins, there was a discrepancy between the nodes visualized at lymphoscintigraphy and the nodes removed at surgery. There were 38 unusually located nodes. Only eight of these were removed surgically; none contained metastases. SN metastases were detected in 22% (53) of patients. There were nine haematoxylin and eosin (HE)-negatives, all of which were found by immunohistochemistry. The false negative rate for the SNB procedure was 4% (2/55). The complication rate was 6% after SNB and 29% after complete node dissection. In conclusion, SN status is a strong prognostic factor in melanoma patients, and SNB has made the approach to radical lymphadenectomy more rational.

aDepartment of Plastic Surgery and Burn Unit

bDepartment of Clinical Physiology and Nuclear Medicine

cDepartment of Clinical Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Correspondence and requests for reprints to Dr Annette Hougaard Chakera, Department of Plastic Surgery and Burn Unit, 2102, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark

Tel: +45 35 55 29 50; fax: +45 35 45 21 02;

e-mail: hougaard_jensen@hotmail.com

Received 23 August 2003 Accepted (after revision) 4 October 2004

© 2004 Lippincott Williams & Wilkins, Inc.