Predictive role of preoperative lymphoscintigraphy on the status of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma

Nicola Solari, Marco Gipponi, Mattia Stella, Paola Queirolo, Carmine Di Somma, Giuseppe Villa, Arnoldo Piccardo, Marina Gualco, Francesco Cardinale, Ferdinando Cafiero

Research output: Contribution to journalArticle

Abstract

We reviewed our experience to assess the predictive role of preoperative lymphoscintigraphy with regard to the pathological status of sentinel lymph node (sN) in patients with cutaneous melanoma, to optimize the surgical treatment planning with regard to the use of intraoperative frozen section examination of sN. Eighty-eight patients with clinically node-negative cutaneous melanoma pT 1b-T 4 stage underwent preoperative lymphoscintigraphy for the lymphatic mapping of sN. A lymphoscintigraphic 'score' (from L1 to L5) was developed based on the ratio of radiotracer concentration within sN nodes as compared with the injection site. Our score allowed us to foresee that sN of patients with thick melanomas (T 3 and T 4) and a low preoperative score (L1-L2-L3) had a 90% expected likelihood (P <0.001) of harboring metastasis, whereas sN in patients with thin melanomas (T 1b-T 2) and high preoperative score (from L4 to L5) showed a 100% likelihood of being metastasis free. In conclusion, the sN is a reliable predictor of regional lymph node status in patients with cutaneous malignant melanoma. Moreover, we suggest that a low score (L1-L2-L3) associated with a thick melanoma is a good predictive factor of the positive sN involvement. This information could be useful in scheduling the intraoperative frozen-section examination with an expected benefit of a positive test in almost 90% of patients. Such patients might be selected for a 'one-stage' procedure with a more effective cost/benefit ratio and decreased hospitalization costs.

Original languageEnglish
Pages (from-to)243-251
Number of pages9
JournalMelanoma Research
Volume19
Issue number4
DOIs
Publication statusPublished - Aug 2009

Fingerprint

Lymphoscintigraphy
Melanoma
Skin
Frozen Sections
Neoplasm Metastasis
Sentinel Lymph Node
Cost-Benefit Analysis
Hospitalization
Lymph Nodes
Costs and Cost Analysis
Injections

Keywords

  • Melanoma
  • Preoperative lymphatic mapping
  • Sentinel lymph node

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Dermatology

Cite this

Predictive role of preoperative lymphoscintigraphy on the status of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma. / Solari, Nicola; Gipponi, Marco; Stella, Mattia; Queirolo, Paola; Di Somma, Carmine; Villa, Giuseppe; Piccardo, Arnoldo; Gualco, Marina; Cardinale, Francesco; Cafiero, Ferdinando.

In: Melanoma Research, Vol. 19, No. 4, 08.2009, p. 243-251.

Research output: Contribution to journalArticle

Solari, Nicola ; Gipponi, Marco ; Stella, Mattia ; Queirolo, Paola ; Di Somma, Carmine ; Villa, Giuseppe ; Piccardo, Arnoldo ; Gualco, Marina ; Cardinale, Francesco ; Cafiero, Ferdinando. / Predictive role of preoperative lymphoscintigraphy on the status of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma. In: Melanoma Research. 2009 ; Vol. 19, No. 4. pp. 243-251.
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AB - We reviewed our experience to assess the predictive role of preoperative lymphoscintigraphy with regard to the pathological status of sentinel lymph node (sN) in patients with cutaneous melanoma, to optimize the surgical treatment planning with regard to the use of intraoperative frozen section examination of sN. Eighty-eight patients with clinically node-negative cutaneous melanoma pT 1b-T 4 stage underwent preoperative lymphoscintigraphy for the lymphatic mapping of sN. A lymphoscintigraphic 'score' (from L1 to L5) was developed based on the ratio of radiotracer concentration within sN nodes as compared with the injection site. Our score allowed us to foresee that sN of patients with thick melanomas (T 3 and T 4) and a low preoperative score (L1-L2-L3) had a 90% expected likelihood (P <0.001) of harboring metastasis, whereas sN in patients with thin melanomas (T 1b-T 2) and high preoperative score (from L4 to L5) showed a 100% likelihood of being metastasis free. In conclusion, the sN is a reliable predictor of regional lymph node status in patients with cutaneous malignant melanoma. Moreover, we suggest that a low score (L1-L2-L3) associated with a thick melanoma is a good predictive factor of the positive sN involvement. This information could be useful in scheduling the intraoperative frozen-section examination with an expected benefit of a positive test in almost 90% of patients. Such patients might be selected for a 'one-stage' procedure with a more effective cost/benefit ratio and decreased hospitalization costs.

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