A D Murphy1, A Britten2, B Powell3. 1. St. George's Melanoma Unit, Dept. of Plastic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK. Electronic address: Adrian.murphy@mac.com. 2. Dept. of Medical Physics, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK. 3. St. George's Melanoma Unit, Dept. of Plastic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
Abstract
BACKGROUND: The surgeon needs a practical rule to follow when deciding whether to excise a lymph node during sentinel node biopsy (SLNB). The "10% rule" dictates that all nodes with a radiation count of greater than 10% of the hottest node and all blue nodes should be removed, and this study observes the effects of following this rule in SLNB in melanoma. METHODS: We reviewed the records of 665 patients with primary melanoma who underwent sentinel lymph node over a 5-year period (2007-2011). RESULTS: 2064 nodes were identified in 898 nodal basins in 665 patients. 141 (21%) patients had at least one positive sentinel node. 105 positive nodal basins were identified in which more than one sentinel node was removed. In 18 of these, a less radioactive node was positive for tumour when the most radioactive node was negative. Of 175 positive nodes 157 (90%) contained blue dye staining. For cases in which the positive sentinel node was not the hottest node, the positive node had apparent blue dye staining in all 18 cases (100%), and was the second hottest node in the basin. CONCLUSION: In this series removing just the hottest node and all blue nodes would not have missed a single positive basin and would have resulted in a 38% reduction in the number of nodes removed compared to those taken following the 10% rule, without changing the staging in any patient.
BACKGROUND: The surgeon needs a practical rule to follow when deciding whether to excise a lymph node during sentinel node biopsy (SLNB). The "10% rule" dictates that all nodes with a radiation count of greater than 10% of the hottest node and all blue nodes should be removed, and this study observes the effects of following this rule in SLNB in melanoma. METHODS: We reviewed the records of 665 patients with primary melanoma who underwent sentinel lymph node over a 5-year period (2007-2011). RESULTS: 2064 nodes were identified in 898 nodal basins in 665 patients. 141 (21%) patients had at least one positive sentinel node. 105 positive nodal basins were identified in which more than one sentinel node was removed. In 18 of these, a less radioactive node was positive for tumour when the most radioactive node was negative. Of 175 positive nodes 157 (90%) contained blue dye staining. For cases in which the positive sentinel node was not the hottest node, the positive node had apparent blue dye staining in all 18 cases (100%), and was the second hottest node in the basin. CONCLUSION: In this series removing just the hottest node and all blue nodes would not have missed a single positive basin and would have resulted in a 38% reduction in the number of nodes removed compared to those taken following the 10% rule, without changing the staging in any patient.
Authors: Andrei Rios-Cantu; Ying Lu; Victor Melendez-Elizondo; Michael Chen; Alejandra Gutierrez-Range; Niloofar Fadaki; Suresh Thummala; Carla West-Coffee; James Cleaver; Mohammed Kashani-Sabet; Stanley P L Leong Journal: Clin Exp Metastasis Date: 2017-07-11 Impact factor: 5.150
Authors: Annie K Kogler; Andrew M Polemi; Surabhi Nair; Stanislaw Majewski; Lynn T Dengel; Craig L Slingluff; Brian Kross; S J Lee; J E McKisson; John McKisson; Andrew G Weisenberger; Benjamin L Welch; Thomas Wendler; Philipp Matthies; Joerg Traub; Michael Witt; Mark B Williams Journal: EJNMMI Res Date: 2020-11-11 Impact factor: 3.138