Timing of sentinel lymph node mapping after lymphoscintigraphy

David C. White, Frank R. Schuler, Scott K. Pruitt, Donna K. Culhane, Hilliard F. Seigler, R. Edward Coleman, Douglas Tyler

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background. Sentinel lymph node (SLN) mapping is an effective technique for staging patients with melanoma. In an attempt to avoid reinjection of radiolabeled colloid and facilitate SLN mapping at the time of surgery, we examined whether residual radioactivity from preoperative lymphoscintigraphy could be used to accurately identify SLNs during surgery 18 to 24 hours later. Methods. Forty-six patients with newly diagnosed melanoma underwent injection of 0.22-μm filtered technetium 99m-labeled sulfur colloid followed by lymphoscintigraphy. Patients returned the next day for SLN biopsy with Isosulfan blue dye and the hand-held γ-probe to identify SLNs. Thirty of 46 patients underwent repeat imaging before operation. No patient had reinjection of radiocolloid. Results. Ninety-five SLNs were identified on initial lymphoscintigraphy, and repeat imaging on the day of surgery confirmed all SLNs previously identified. A total of 122 SLNs (2.65 per patient) were resected from 58 basins. Eighty-four (69%) of 122 SLNs stained blue, and 118 (97%) of 122 SLNs had in vivo γ-counts greater than 4 times background. Microscopic metastases were present in 13 (10.7%) of 122 SLNs in 12 (26.1%) of 46 patients. There have been no recurrences over a mean follow- up time of 320 days. Conclusions. Intraoperative γ-probe detection combined with blue dye injection is highly effective in identifying SLNs 18 to 24 hours after injection of 0.22-μm filtered (99m)Tc-sulfur colloid. Reinjection of radiocolloid is not required. This technique avoids radiopharmaceutical administration in the operating room, minimizes radiation exposure, and increases scheduling flexibility.

Original languageEnglish (US)
Pages (from-to)156-161
Number of pages6
JournalSurgery
Volume126
Issue number2
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Lymphoscintigraphy
Colloids
Injections
Melanoma
Coloring Agents
Technetium Tc 99m Sulfur Colloid
Sentinel Lymph Node Biopsy
Radiopharmaceuticals
Technetium
Operating Rooms
Sentinel Lymph Node
Ambulatory Surgical Procedures
Sulfur
Radioactivity
Hand
Neoplasm Metastasis
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

White, D. C., Schuler, F. R., Pruitt, S. K., Culhane, D. K., Seigler, H. F., Coleman, R. E., & Tyler, D. (1999). Timing of sentinel lymph node mapping after lymphoscintigraphy. Surgery, 126(2), 156-161. https://doi.org/10.1016/S0039-6060(99)70149-2

Timing of sentinel lymph node mapping after lymphoscintigraphy. / White, David C.; Schuler, Frank R.; Pruitt, Scott K.; Culhane, Donna K.; Seigler, Hilliard F.; Coleman, R. Edward; Tyler, Douglas.

In: Surgery, Vol. 126, No. 2, 1999, p. 156-161.

Research output: Contribution to journalArticle

White, DC, Schuler, FR, Pruitt, SK, Culhane, DK, Seigler, HF, Coleman, RE & Tyler, D 1999, 'Timing of sentinel lymph node mapping after lymphoscintigraphy', Surgery, vol. 126, no. 2, pp. 156-161. https://doi.org/10.1016/S0039-6060(99)70149-2
White DC, Schuler FR, Pruitt SK, Culhane DK, Seigler HF, Coleman RE et al. Timing of sentinel lymph node mapping after lymphoscintigraphy. Surgery. 1999;126(2):156-161. https://doi.org/10.1016/S0039-6060(99)70149-2
White, David C. ; Schuler, Frank R. ; Pruitt, Scott K. ; Culhane, Donna K. ; Seigler, Hilliard F. ; Coleman, R. Edward ; Tyler, Douglas. / Timing of sentinel lymph node mapping after lymphoscintigraphy. In: Surgery. 1999 ; Vol. 126, No. 2. pp. 156-161.
@article{95b6376120a24d7f88eacb785ee5928d,
title = "Timing of sentinel lymph node mapping after lymphoscintigraphy",
abstract = "Background. Sentinel lymph node (SLN) mapping is an effective technique for staging patients with melanoma. In an attempt to avoid reinjection of radiolabeled colloid and facilitate SLN mapping at the time of surgery, we examined whether residual radioactivity from preoperative lymphoscintigraphy could be used to accurately identify SLNs during surgery 18 to 24 hours later. Methods. Forty-six patients with newly diagnosed melanoma underwent injection of 0.22-μm filtered technetium 99m-labeled sulfur colloid followed by lymphoscintigraphy. Patients returned the next day for SLN biopsy with Isosulfan blue dye and the hand-held γ-probe to identify SLNs. Thirty of 46 patients underwent repeat imaging before operation. No patient had reinjection of radiocolloid. Results. Ninety-five SLNs were identified on initial lymphoscintigraphy, and repeat imaging on the day of surgery confirmed all SLNs previously identified. A total of 122 SLNs (2.65 per patient) were resected from 58 basins. Eighty-four (69{\%}) of 122 SLNs stained blue, and 118 (97{\%}) of 122 SLNs had in vivo γ-counts greater than 4 times background. Microscopic metastases were present in 13 (10.7{\%}) of 122 SLNs in 12 (26.1{\%}) of 46 patients. There have been no recurrences over a mean follow- up time of 320 days. Conclusions. Intraoperative γ-probe detection combined with blue dye injection is highly effective in identifying SLNs 18 to 24 hours after injection of 0.22-μm filtered (99m)Tc-sulfur colloid. Reinjection of radiocolloid is not required. This technique avoids radiopharmaceutical administration in the operating room, minimizes radiation exposure, and increases scheduling flexibility.",
author = "White, {David C.} and Schuler, {Frank R.} and Pruitt, {Scott K.} and Culhane, {Donna K.} and Seigler, {Hilliard F.} and Coleman, {R. Edward} and Douglas Tyler",
year = "1999",
doi = "10.1016/S0039-6060(99)70149-2",
language = "English (US)",
volume = "126",
pages = "156--161",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Timing of sentinel lymph node mapping after lymphoscintigraphy

AU - White, David C.

AU - Schuler, Frank R.

AU - Pruitt, Scott K.

AU - Culhane, Donna K.

AU - Seigler, Hilliard F.

AU - Coleman, R. Edward

AU - Tyler, Douglas

PY - 1999

Y1 - 1999

N2 - Background. Sentinel lymph node (SLN) mapping is an effective technique for staging patients with melanoma. In an attempt to avoid reinjection of radiolabeled colloid and facilitate SLN mapping at the time of surgery, we examined whether residual radioactivity from preoperative lymphoscintigraphy could be used to accurately identify SLNs during surgery 18 to 24 hours later. Methods. Forty-six patients with newly diagnosed melanoma underwent injection of 0.22-μm filtered technetium 99m-labeled sulfur colloid followed by lymphoscintigraphy. Patients returned the next day for SLN biopsy with Isosulfan blue dye and the hand-held γ-probe to identify SLNs. Thirty of 46 patients underwent repeat imaging before operation. No patient had reinjection of radiocolloid. Results. Ninety-five SLNs were identified on initial lymphoscintigraphy, and repeat imaging on the day of surgery confirmed all SLNs previously identified. A total of 122 SLNs (2.65 per patient) were resected from 58 basins. Eighty-four (69%) of 122 SLNs stained blue, and 118 (97%) of 122 SLNs had in vivo γ-counts greater than 4 times background. Microscopic metastases were present in 13 (10.7%) of 122 SLNs in 12 (26.1%) of 46 patients. There have been no recurrences over a mean follow- up time of 320 days. Conclusions. Intraoperative γ-probe detection combined with blue dye injection is highly effective in identifying SLNs 18 to 24 hours after injection of 0.22-μm filtered (99m)Tc-sulfur colloid. Reinjection of radiocolloid is not required. This technique avoids radiopharmaceutical administration in the operating room, minimizes radiation exposure, and increases scheduling flexibility.

AB - Background. Sentinel lymph node (SLN) mapping is an effective technique for staging patients with melanoma. In an attempt to avoid reinjection of radiolabeled colloid and facilitate SLN mapping at the time of surgery, we examined whether residual radioactivity from preoperative lymphoscintigraphy could be used to accurately identify SLNs during surgery 18 to 24 hours later. Methods. Forty-six patients with newly diagnosed melanoma underwent injection of 0.22-μm filtered technetium 99m-labeled sulfur colloid followed by lymphoscintigraphy. Patients returned the next day for SLN biopsy with Isosulfan blue dye and the hand-held γ-probe to identify SLNs. Thirty of 46 patients underwent repeat imaging before operation. No patient had reinjection of radiocolloid. Results. Ninety-five SLNs were identified on initial lymphoscintigraphy, and repeat imaging on the day of surgery confirmed all SLNs previously identified. A total of 122 SLNs (2.65 per patient) were resected from 58 basins. Eighty-four (69%) of 122 SLNs stained blue, and 118 (97%) of 122 SLNs had in vivo γ-counts greater than 4 times background. Microscopic metastases were present in 13 (10.7%) of 122 SLNs in 12 (26.1%) of 46 patients. There have been no recurrences over a mean follow- up time of 320 days. Conclusions. Intraoperative γ-probe detection combined with blue dye injection is highly effective in identifying SLNs 18 to 24 hours after injection of 0.22-μm filtered (99m)Tc-sulfur colloid. Reinjection of radiocolloid is not required. This technique avoids radiopharmaceutical administration in the operating room, minimizes radiation exposure, and increases scheduling flexibility.

UR - http://www.scopus.com/inward/record.url?scp=0032863296&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032863296&partnerID=8YFLogxK

U2 - 10.1016/S0039-6060(99)70149-2

DO - 10.1016/S0039-6060(99)70149-2

M3 - Article

VL - 126

SP - 156

EP - 161

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 2

ER -