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The Impact of Lymphoscintigraphy Technique on the Outcome of Sentinel Node Biopsy in 1,313 Patients with Cutaneous Melanoma: An Italian Multicentric Study (SOLISM–IMI)

Carlo Riccardo Rossi, MD1, Gian Luca De Salvo, MD2, Giuseppe Trifirò, MD3, Simone Mocellin, PhD1, Giorgio Landi, MD4, Giuseppe Macripò, MD5, Paolo Carcoforo, MD6, Giuseppe Ricotti, MD7, Giuseppe Giudice, MD8, Franco Picciotto, MD9, Davide Donner, MD10, Franco Di Filippo, MD11, Maria Cristina Montesco, MD12, Dario Casara, MD13, Mauro Schiavon, MD14, Mirto Foletto, MD1, Federica Baldini, MD3 and Alessandro Testori, MD3

1 Clinica Chirurgica 2, Università di Padova, Padova, Italy; 2 Clinical Trials and Biostatistical Unit, Istituto Oncologico Veneto, Padova, Italy; 3 Melanoma Unit, European Institute of Oncology, Milano, Italy; 4 Dermatochirurgia, Ospedale Bufalini, Cesena, Italy; 5 Dermatochirurgia, Ospedale S. Lazzaro-Molinette, Torino, Italy; 6 Clinica Chirurgica, Arcispedale S. Anna, Ferrara, Italy; 7 Dermatologia–Dermochirurgia, Ospedale Sestilli, Ancona, Italy; 8 Chirurgia Plastica, Università di Bari, Bari, Italy; 9 Chirurgia Dermatologica, Istituto Ricerca e Cura del Cancro di Candiolo, Candiolo, Italy; 10 Medicina Nucleare, Ospedale S. Chiara, Trento, Italy; 11 Divisione di Chirurgia 1, Istituto Regina Elena, Roma, Italy; 12 Anatomia Patologica, Università di Padova, Padova, Italy; 13 Medicina Nucleare 2, Azienda Ospedaliera di Padova, Padova, Italy; and 14 Chirurgia Plastica e Centro Ustioni, Azienda Ospedaliera di Udine, Udine, Italy; on behalf of the Italian Melanoma Intergroup (IMI)


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  		FIGURE 1.  Lymphoscintigraphy for detection of SNs in patients with cutaneous melanoma. Schematic view of how the different number of radiotracer injections might affect the outcome of the procedure. (A) Single injection, X (large volume), might only enter central lymphatic vessels (with respect to the scar following primary melanoma resection), thus missing those potentially involved by malignant cells; moreover, the large volume of the radiotracer might be responsible for identification of non-SNs. (B) Multiple injections, X, might instead enter peripheral lymphatic vessels and thus identify sentinel nodes involved by metastatic melanoma cells; in addition, the low volume characterizing multiple injections might avoid identification of second tier(s). Arrows represent lymphatic flow.

 




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