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The pathologist's role in sentinel lymph node evaluation.

A J Cochran1

  • 1Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, UCLA School of Medicine, Los Angeles, CA 90095-1732, USA.

Seminars in Nuclear Medicine
|February 3, 2000
PubMed
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Selective lymph node dissection identifies melanoma in sentinel nodes for high-risk patients. This approach avoids unnecessary dissections, improving patient management for melanoma metastasis.

Area of Science:

  • Oncology
  • Surgical Pathology
  • Nuclear Medicine

Background:

  • High-risk melanoma management historically involved wide local excision with elective or therapeutic lymph node dissection.
  • This approach often led to overtreatment or delayed treatment of nodal metastases.

Purpose of the Study:

  • To evaluate the efficacy and findings of selective lymph node dissection (SLND) in patients with high-risk primary melanoma.
  • To assess the accuracy and challenges of sentinel lymph node (SLN) evaluation for melanoma metastasis.

Main Methods:

  • SLND involves preoperative lymphoscintigraphy to identify draining lymph nodes.
  • Intraoperative use of isosulfan blue dye and technetium-labeled albumin guides SLN identification and excision.
  • Pathological evaluation of SLNs using hematoxylin and eosin (H&E) staining and immunohistochemistry.

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Main Results:

  • Melanoma cells were identified in 17.8% of 1,119 examined sentinel lymph nodes from 669 patients.
  • Metastasis was most commonly found in a single SLN (67%), with 2 nodes positive in 25% of cases.
  • Tumor cells were often found in the peripheral nodal sinus, with immunohistochemistry required in approximately 40% of cases for detection.

Conclusions:

  • Selective lymph node dissection is an effective method for staging regional lymph nodes in high-risk melanoma.
  • Accurate pathological assessment of sentinel nodes, including immunohistochemistry, is crucial for identifying micrometastases.
  • SLN status correlates with primary tumor characteristics, such as Breslow thickness and Clark level.