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Failure to Remove True Sentinel Nodes Can Cause Failure of the Sentinel Node Biopsy Technique: Evidence from Antimony Concentrations in False-Negative Sentinel Nodes from Melanoma Patients

From the Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute (RAS, JFT, L-XLL, VSKK, JGMcK, RFU, HMS, JRS, SWMcC) and Department of Anatomical Pathology (RAS, RS, SWMcC), Royal Prince Alfred Hospital, Camperdown; Departments of Surgery (JFT, HMS, JRS) and Medicine (RFU), University of Sydney; and Department of Chemistry, Materials and Forensic Science (AB, MD, PD), Broadway, New South Wales, Australia.

Correspondence: Address correspondence and reprint requests to: Richard Scolyer, MD, Department of Anatomical Pathology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Fax: 61-2-9515-8405; E-mail: richard.scolyer{at}email.cs.nsw.gov.au

ABSTRACT

We have recently found that antimony (originating from the technetium 99m antimony trisulfide colloid, used for preoperative lymphoscintigraphy) can be measured in tissue sections from archival paraffin blocks of sentinel nodes (SNs) by means of inductively coupled plasma mass spectrometry (ICP-MS) to confirm that removed nodes are true SNs. We performed a retrospective analysis of antimony concentrations in all our false-negative (FN) SNs to determine whether errors in lymphadenectomy (i.e., failure to remove true SNs) may be a cause of FN SN biopsies (SNBs). Among 27 patients with an FN SNB, metastases were found on histopathologic review of the original slides or additional sections in 7 of 23 patients for which they were available; however, antimony concentrations were low in 5 of 20 presumptive SNs. Our results suggest that an FN SNB can occur because of failure to remove the true SN as well as histopathologic misdiagnosis.

Key Words: False-negative • Melanoma • Regional recurrence • Sentinel node

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