The impact of lymphoscintigraphy technique on the outcome of sentinel node biopsy in 1,313 patients with cutaneous melanoma: an Italian Multicentric Study (SOLISM-IMI)
Carlo Riccardo Rossi, Gian Luca De Salvo, Giuseppe Trifirò, Simone Mocellin, Giorgio Landi, Giuseppe Macripò, Paolo Carcoforo, Giuseppe Ricotti, Giuseppe Giudice, Franco Picciotto, Davide Donner, Franco Di Filippo, Maria Cristina Montesco, Dario Casara, Mauro Schiavon, Mirto Foletto, Federica Baldini, Alessandro Testori, Carlo Riccardo Rossi, Gian Luca De Salvo, Giuseppe Trifirò, Simone Mocellin, Giorgio Landi, Giuseppe Macripò, Paolo Carcoforo, Giuseppe Ricotti, Giuseppe Giudice, Franco Picciotto, Davide Donner, Franco Di Filippo, Maria Cristina Montesco, Dario Casara, Mauro Schiavon, Mirto Foletto, Federica Baldini, Alessandro Testori
Abstract
An observational multicentric Italian trial on sentinel node biopsy (SNB) in melanoma patients was performed to diffuse a common SNB protocol nationwide (Italy). We report herein the results of this trial. The influence of some technical aspects on the outcome of SNB was also investigated, because a certain degree of variability was accepted in performing lymphoscintigraphy.
Methods: From January 2000 to December 2002, 1,313 consecutive patients with primary cutaneous melanoma (Breslow thickness, >1.0 mm or <1.0 mm but with ulceration, Clark level IV-V, presence of regression) were enrolled by 23 centers. One half to 1 mL of 99mTc-labeled human albumin colloid, at a suggested dosage of 5-15 or 30-70 MBq, was injected intradermally, closely around the scar, the same day or the day before SNB. Intraoperatively, Patent blue was associated when a definitive wide excision of the primary was required. A positive sentinel node (SN) was defined when containing melanoma cells detected by either hematoxylin-eosin or immunohistochemistry (S100 and HMB45 antibodies). All patients underwent regular follow-up. False-negative cases were considered when lymph node metastases occurred in the same lymphatic basin of SN biopsy (SNB) during follow-up. A quality control program has been performed for the surgical procedure and for the histologic diagnosis.
Results: The SN identification rate was 99.3%. The axilla was the site of the SN in 52.5% of the cases. The mean number of SNs was 2.0 (range, 1-17) and only 1 node was removed in 45.4%. The positivity and false-negative rates were 16.9% and 14.7%, respectively (median follow-up, 31 mo). On multivariate analysis (logistic and linear regression) only the number of peritumor injections was inversely associated with the number of excised SNs (P = 0.002), whereas none of the technical variables showed an independent impact on SN status when Breslow thickness was included as a control variable.
Conclusion: The number of peritumor injections seems to influence the outcome of lymphoscintigrapy in melanoma patients undergoing SNB. If these results are confirmed in a controlled trial, 3 injections at least should be recommended.
Source: PubMed