Role of lymphoscintigraphy and gamma probe guided intraoperative sentinel lymph node biopsy on minimally invasive surgical procedure in skin cancers

Purpose: In this study, we aimed to determine the role of lymphoscintigraphy in patient management of sentinel lymph node (SLN) biopsy. Materials and Methods: 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma) were included in the study. Tc-99m Nanocolloid intradermal injection was applied to all patients on the day of operation. The projections of the sentinel lymph nodes on the skin were marked during preoperative lymphoscintigraphy. Patients were taken into operation after the marking. The lymph nodes with projections on the skin were detected by intraoperative gamma probe and excised. After removing all the sentinel nodes for histopathological examination, care was taken to reduce the residual radioactivity count in the bed, where sentinel lymph nodes were removed, to less than 10% of the activity of the most active activity of the resected node. Results: A total of 86 SLNs and 54 non-SLNs were surgically removed and all nodes were sent to the Department of Pathology for histopathological examination. Four patients had metastases in sentinel lymph nodes. These patients were reoperated under elective conditions for extensive surgery. Conclusion: Lymphatic mapping method with lymphoscintigraphy and intraoperative gamma probe have a high specificity and sensitivity ratio and minimize the morbidity. This method was thought to be a routine procedure in malignant skin tumors because of its determination of micrometastases, eliminating possible metastasis pathways, staging and guiding adjuvant therapy.