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Reproducibility of Lymphoscintigraphy in Cutaneous Melanoma: Can We Accurately Detect the Sentinel Lymph Node by Expanding the Tracer Injection Distance from the Tumor Site?

Department of Nuclear Medicine and Endocrinology and Department of Dermatology, Salzburg State Hospital, Salzburg; and Department of Radiology and Nuclear Medicine, Hospital Barmherzige Brüder, Salzburg, Austria

View larger version (13K): [in a new window]   FIGURE 1. Schematic presentation of injection sites shows biopsy scar (A) and primary tumor (B), with four close injection sites and four distant injection sites 10 mm from close injection sites.

View larger version (62K): [in a new window]   FIGURE 2. Comparison of lymphoscintigraphic images in patient with melanoma on lower leg. (A) Early close-injection image shows three sentinel nodes in left groin with different radiotracer uptake. Two afferent lymph channels are clearly visible, and one is discreetly visible. (B) Distant-injection image shows same sentinel nodes.

View larger version (50K): [in a new window]   FIGURE 3. Comparison of lymphoscintigraphic images in patient with melanoma at midline of back. Injection sites are covered by lead sheet. Close-injection images (A and B) show convergence of several lymph channels toward single node in left axillary basin and one lymph channel to one SLN in right axilla. Distant-injection images (C and D) show additional lymph channel draining to additional SLN in right axilla. Dynamic image (C) shows delayed appearance of additional SLN.

View larger version (28K): [in a new window]   FIGURE 4. Comparison of lymphoscintigraphic images in patient with melanoma on lower leg. Close-injection images (A and B) show three sentinel nodes in left groin. Only one lymph channel is visible. Distant-injection images (C and D) show same sentinel nodes but with different uptake of radiotracer. Dynamic image (C) shows earlier appearance of lymph node lying more distant from injection site.