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Review and Evaluation of Sentinel Node Procedures in 250 Melanoma Patients With a Median Follow-Up of 6 Years

From the Departments of Surgery (SHE, OEN, BBRK) and Nuclear Medicine (RAVO, CAH), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.

Correspondence: Address correspondence and reprint requests to: Susanne H. Estourgie, MD, Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Fax: 31-20-512-2554; E-mail: s.estourgie{at}nki.nl

Background: The aim of this study was to evaluate the results of sentinel node biopsy in cutaneous melanoma at our institute.

Methods: A total of 250 patients with cutaneous melanoma were studied prospectively. Preoperative lymphoscintigraphy was performed after injection of ^99mTc-nanocolloid intradermally around the primary tumor or biopsy site (.32 mL, 65.5 MBq [1.8 mCi]). The sentinel node was surgically identified with the aid of patent blue dye and a gamma ray detection probe. The median follow-up was 72 months.

Results: Lymphoscintigraphic visualization was 100%, and surgical identification was 99.6%. In 60 patients (24%), 1 or more sentinel nodes were tumor positive at initial pathology evaluation. Late complications after sentinel node biopsy of the remaining 190 patients were seen in 35 patients (18%). The false-negative rate was 9%. In-transit metastases were seen in 7% of sentinel node–negative and 23% of sentinel node–positive patients. The estimated 5-year overall survival rates were 89% and 64%, respectively (P < .001).

Conclusions: This study confirms that the status of the sentinel node is a strong independent prognostic factor. The false-negative rate and the incidence of in-transit metastases in sentinel node–positive patients are high and have to be weighed against the possible survival benefit of early removal of nodal metastases.

Key Words: Analysis • Melanoma • Morbidity • Recurrence • Sentinel node • Survival

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