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. 2013 May;20(5):1714-21.
doi: 10.1245/s10434-012-2841-1. Epub 2013 Jan 12.

Individualized surgery: gamma-probe-guided lymphadenectomy in patients with clinically enlarged lymph node metastases from melanomas

Lutz Kretschmer  1 , Carsten-Oliver Sahlmann, Pavel Bardzik, Christina Mitteldorf, Hans-Joachim Helms, Johannes Meller, Michael Peter Schön, Hans Peter Bertsch
Affiliations

Individualized surgery: gamma-probe-guided lymphadenectomy in patients with clinically enlarged lymph node metastases from melanomas

Lutz Kretschmer et al. Ann Surg Oncol. 2013 May.

Abstract

Background: The value of a preoperative lymphoscintigraphy in melanoma patients with clinically evident regional lymph node metastases has not been studied. Therapeutic lymph node dissection (TLND) is regarded as the clinical standard, but the appropriate extent of TLND is controversial in all lymphatic basins.

Patients and methods: Of the 115 consecutive patients with surgery on palpable lymph node metastases, 34 received a pre-operative lymphoscintigraphy. Lymphatic drainage to a second nodal basin outside the clinically involved basin was found in 15 cases. In 13 patients, the ectopic tumor-draining lymph nodes were excised as in a sentinel node biopsy. The lymph nodes from the TLND specimens were postoperatively separated and classified as either radioactive or non-radioactive.

Results: A total of 493 lymph nodes were examined pathologically. The largest macrometastasis maintained the ability to take up radiotracer in 77% of cases. Radioactively labeled lymph nodes carried a higher risk of being involved with metastasis. The proportions of tumor involvement for radioactive and non-radioactive lymph nodes were 44.5 and 16.9%, respectively (P=0.00002). Of the 13 ectopic nodal basins surgically explored, six harbored clinically occult metastases.

Conclusion: In patients undergoing TLND for palpable metastases, tumor-draining lymph nodes in a second, ectopic nodal basin should be excised, because they could be affected by occult metastasis. With respect to radioactive lymph nodes situated within the nodal basin of the macrometastasis but beyond the borders of a less-radical lymphadenectomy, further studies are needed.

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Figures

Fig. 1
Fig. 1
Local recurrence rates (including relapses after generalized metastases) (a) and survival rates (b) for patients with clinically enlarged regional lymph node metastases who had either gamma-guided or classical therapeutic lymph node dissection (TLND). The estimated local failure- and survival rates for all 77 patients with palpable metastases were 25 and 39 %, respectively
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