Non-Sentinel Lymph Node Detection during Sentinel Lymph Node Biopsy in Not-Complete-Lymph-Node-Dissection Era: A New Technique for Better Staging and Treating Melanoma Patients

Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection...

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Bibliographic Details
Published in:Journal of clinical medicine 2021-09, Vol.10 (19), p.4319
Main Authors: Picciotto, Franco, Avallone, Gianluca, Castellengo, Federico, Merli, Martina, Caliendo, Virginia, Senetta, Rebecca, Lesca, Adriana, Deandreis, Désirée, Fierro, Maria Teresa, Quaglino, Pietro, Ribero, Simone
Format: Article
Language:English
Subjects:
Biopsy
Clinical medicine
Diagnostic tests
Dissection
Localization
Lymphatic system
Melanoma
Neck
Patients
Surgeons
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Summary:Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography-computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically “excluded” lymph nodes, guiding the surgeon’s hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a “classic” setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm10194319