Pre-operative lymphoscintigraphy is an essential part of sentinel node biopsy in skin melanoma patients with primary tumor located on trunk

Background: In Poland sentinel lymph node biopsy is a standard procedure of treatment of skin melanoma patients for third level reference centers. The method requires special equipment. Therefore, the availability of the method is limited.
Objectives: To assess whether pre- -operative lymphoscintigraphy is a necessary part of sentinel node biopsy.
Material and Methods: From 1 December 1999 to 31 July 2003 in the Department of Surgical Oncology, Medical University of Łódź, 100 patients with trunk skin melanoma underwent the sentinel node biopsy. In the studied group there were 39 women (39%) and 61 men (61%). Age ranged from 32 to 78. In all the patients pre-operative lymphoscintigraphy, intra-operative blue dye mapping and intra-operative detection of gamma radiation were performed.
Results: Pre-operative lymphoscintigraphy allowed for the detection of sentinel node (s) in all 100 studied patients (100%). In 63 of them (63%) the tracer flowed to one group of regional lymph nodes. In the remaining 37 patients (37%) the tracer flowed to two or three different lymph nodes groups. Sentinel node (s) were detected intra-operatively in 98 patients (98%). In all these patients sentinel nodes were identified using intra-operative detection of gamma radiation. Pigmentation of sentinel node (s) was found intra-operatively in 78 patients (78%). The difference between intra-operative detection rate of sentinel node using gamma- -probe (98%) and using blue-dye technique (78%) was statistically significant (P<0.05).
Conclusion: In 37 patients in whom the tracer flowed to two or more groups of lymph nodes, the proper surgical procedure would not be possible if preoperative lymphoscintigraphy was not made. The pre-operative lymphoscintigraphy is an essential part of sentinel node biopsy in skin melanoma patients with primary tumor located on trunk.