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Localization of Regional Lymph Nodes in Melanomas of the Head and Neck
James C. Alex, MD;
David N. Krag, MD;
Seth P. Harlow, MD;
Sybren Meijer, MD;
Brian W. Loggie, MD;
Joseph Kuhn, MD;
Michele Gadd, MD;
Donald L. Weaver, MD
Arch Otolaryngol Head Neck Surg. 1998;124:135-140.
Objectives To study the efficacy of gamma-probe radiolocalization of the first draining (sentinel) lymph node (SLN) in stage N0 melanoma of the head and neck and to evaluate its potential role in the staging and treatment of this disease.
Design Gamma-probe radiolocalization, a new alternative to blue-dye lymphatic mapping, uses a scintillation (gamma) probe to identify radiolabeled SLNs. In a consecutive sample clinical trial, gamma-probe radiolocalization of the SLN is compared with lymphoscintigraphy and blue-dye lymphatic mapping. Follow-ups ranged from 1.7 years to 4 years, with a mean follow-up of 2.5 years.
Setting Tertiary and private care teaching hospital.
Patients Between June 1993 and November 1995, 23 patients with stage N0 intermediate-thickness melanoma of the head and neck were enrolled in this volunteer sample.
Interventions Twenty-four hours prior to surgery, a radioactive tracer was intradermally injected around the circumference of a primary melanoma. Twelve patients also had blue dye injected just prior to surgical resection. Using a handheld gamma probe, radiolabeled lymph nodes were identified and selectively removed with minimal dissection. In patients with nodes with histologic evidence of metastases, a regional lymphadenectomy was performed.
Main Outcome Measures The successful identification of radiolabeled SLNs, the correlation of SLN radiolabeling to lymphoscintigraphy and blue-dye mapping, and the long-term development of regional metastases.
Results Surgeons successfully resected the radiolabeled SLNs in 22 (96%) of 23 patients. The success rate of blue-dye lymphatic mapping was 8 (75%) of 12 patients and lymphoscintigraphy was 20 (91%) of 22 patients. One hundred percent of blue-stained lymph nodes were radiolabeled. The one patient in whom no SLN could be identified developed regional disease at 17 months.
Conclusions Gamma-probe radiolocalization and resection of the radiolabeled SLN is a simple and reliable method of staging regional lymph nodes and determining the need for elective lymphadenectomy.
From the Division of Otolaryngology (Dr Alex) and the Departments of Surgery (Drs Krag and Harlow) and Pathology (Dr Weaver), University of Vermont, Burlington; and the Departments of Surgery, Free University, Amsterdam, the Netherlands (Dr Meijer), Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC (Dr Loggie), Baylor University Medical Center, Dallas, Tex (Dr Kuhn), and Massachusetts General Hospital, Harvard University, Boston (Dr Gadd). Dr Alex is now with the Ear, Nose, and Throat Department, Yale University School of Medicine, New Haven, Conn.
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