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Predictive role of preoperative lymphoscintigraphy on the status of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma
Melanoma Research, 07/31/09

Solari N et al. - In a study to assess the predictive role of preoperative lymphoscintigraphy with regard to pathological status of sentinel lymph node (sN) in pts with cutaneous melanoma, to optimize the surgical treatment planning with regard to use of intraoperative frozen section examination of sN, it was shown that the sN is a reliable predictor of regional lymph node status in these pts. It was suggested that a low score (L1-L2-L3) associated with a thick melanoma is a good predictive factor of positive sN involvement. This information could be useful in scheduling intraoperative frozen-section examination with an expected benefit of a positive test in almost 90% of pts. Pts might be selected for a 'one-stage' procedure with a more effective cost/benefit ratio and decreased hospitalization costs.

Methods

88 pts with clinically node-negative cutaneous melanoma pT1b-T4 stage underwent preoperative lymphoscintigraphy for 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.

Results

The score allowed users to foresee that sN of pts with thick melanomas (T3 and T4) and a low preoperative score (L1-L2-L3) had a 90% expected likelihood of harboring metastasis, whereas sN in pts with thin melanomas (T1b-T2) and high preoperative score (from L4 to L5) showed a 100% likelihood of being metastasis free.

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