Sentinel node detection by preoperative lymphoscintigraphy and intraoperative gamma-probe guidance in melanoma

Aim: The purpose of this work was to prove the clinical significance of nuclear medical procedures in pre- and intraoperative detection of the SLN. Methods: in the past 4 years, we did preoperative lymphoscintigraphy in 214 patients (pts.). intraoperative localisation of the SLN with a handheld gamma probe followed in 150 pts. Results: In 214 pts. 247 lymphatic draining regions were found by preoperative scintigraphy. in 3 pts. with melanoma of the cheek no lymphatics/lymphe nodes could be detected. 14 pts. showed interval lymph nodes. in 150 pts. gamma probe guided SLNE was done. in 2 pts. with supraclavicular primary tumor 4 SLN had been defined by preoperative scintigraphy but only 2 could be found intraoperatively. In ail other cases (98.7%) the sentinel node was detected correctly by the gamma probe and then removed. In 19 of 150 pts. (12.7%) metastases were detected in the pathologic specimen. The incidence of lymph node metastases showed a continuous increase from 0% at tumor stage pT1 to 44% at stage pT4. Conclusion: SLNE is an accurate method to determine nodal involvement in melanoma and minimizes operative invasiveness in melanoma surgery.