Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye

PURPOSE

This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches.

METHODS

0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5%) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN).

RESULTS

It was observed that 88% of SLN were identified. It wasn't found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88%) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation).

CONCLUSION

The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model

OBJECTIVES

This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model.

METHODS

The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient.

RESULT

Our findings showed that in 95% of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82% of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82% of the time.

CONCLUSIONS

Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

Sentinel lymph node biopsy in cutaneous melanoma

PURPOSE

To assess the importance of sentinel lymph node biopsy in patients with cutaneous melanoma.

METHODS

Ninety consecutive non-randomized patients with stages I and II melanoma who underwent sentinel lymph node biopsy were followed up prospectively for six years.

RESULTS

Patients were followed up for a mean period of 30 months. Their mean age was 53.3 years, ranging from 12 to 83 years. Thirty patients were male (37.5%) and 50, female (62.5%). Sentinel lymph node was positive in 32.5% and negative in 67.5%. It was found that the thicker the tumor, the greater the incidence of positive sentinel lymph nodes. In the group of patients with positive sentinel lymph nodes, recurrence occurred in 43.5%, but in those with negative sentinel lymph nodes, in only 7%, what points out to the association of tumor recurrence and positive sentinel lymph nodes. There were no major postoperative complications.

CONCLUSION

Sentinel lymph node biopsy was demonstrated to be a safe method for selecting patients who need therapeutic lymphadenectomy.

[Lymphadenectomy of the inguinal region and pelvis]

The draining lymph nodes of extra-abdominal tumors and malignant lesions of the lower extremity are located in the groin and iliac region. Malignancies with lymphatic drainage into this region include tumors of the anorectum, penis and vulva, skin (melanoma, squamous cell carcinoma), and soft tissue sarcomas. Current clinical research in biology, routes of lymphatic spread, and the possibility of marking the sentinel lymph node has directed lymphadenectomy strategy toward differential procedures, depending on the type of underlying malignancy. The spectrum of lymphadenectomy includes diagnostic lymph node removal of clinically enlarged nodes, removal of the sentinel node, and radical lymphadenectomy. Lymphadenectomy can also be indicated as a palliative procedure. The indications also depend on the type of tumor, previous treatment, and disease prognosis. This review presents the current state of indications and surgical techniques of inguinal and iliacal lymphadenectomy.