Sentinel lymph node biopsy in the pediatric population
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Published on: June 1, 2019
Kenneth W Gow1, Louis B Rapkin, Thomas A Olson
1Division of Pediatric Surgery, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA. kenneth.gow@seattlechildrens.org
Background:
Sentinel lymph node biopsy (SLNB) has only been recently used for childhood neoplasms.
Methods:
We reviewed all patients younger than 19 years who underwent SLNB for 5 years.
Results:
Twenty patients were identified (11 male, 9 female). Sentinel lymph node biopsy was performed for 10 sarcomas (5 synovial, 3 rhabdomyosarcoma, 1 epitheliod, 1 other); 9 skin neoplasms (4 melanomas, 3 Spitz nevi, 2 melanocytomas); and 1 acinic cell carcinoma. All patients underwent Technetium 99m sulfur microcolloid injection and 4-quadrant subdermal injection with Lymphazurin 1% (Autosuture, Norwalk, Conn). Six patients required either sedation for lymphoscintigraphy. Intraoperative gamma probe was used. Primary lesions were found in lower extremity (n = 8), upper extremity (n = 6), trunk (n = 3), and head and neck (n = 3). The lymphatic basins were inguinal (n = 8), axilla (n = 8), neck (n = 3), and both inguinal and axilla (n = 1). At least one lymph node was identified in each procedure. Of 20 patients, 5 (25%) had metastatic disease (4 skin neoplasms and 1 sarcoma). There were no complications in our series, and all patients are alive with no recurrence at an average follow-up of 2.2 years.
Conclusions:
Sentinel lymph node biopsy allows for an accurate biopsy in children. However, some younger patients may require sedation, and it may be more challenging to isolate the sentinel node.
