[Kinetic values of lymphoscintigraphy of sentinel ganglion in cutaneous cervicofacial melanomas]. / Valeurs cinetiques de la lymphoscintigraphie du ganglion sentinelle dans les melanomes malins cutanes cervico-faciaux.

OBJECTIVE: The aim of this study was to evaluate the lymphoscintigraphy appearance time (LAT) of the sentinel lymph node (SLN) in head and neck cutaneous melanoma and to determine whether a correlation exists between LAT and SLN status (negativity or positivity). DESIGN/SETTING: In vivo study. MATERIALS AND METHODS: A retrospective cohort of 33 patients with Breslow index >or= 1.5 mm, Clark index >or= 4 mm, and ulceration > 1 mm underwent a lymphoscintigraphy and SLN biopsy for a cutaneous head and neck melanoma. MAIN OUTCOME MEASURES: LAT was noted and correlated to SLN status, Breslow and Clark indices, ulceration, and recurrence. RESULTS: Sixty SLNs were identified; 58 were removed, and 17 were positive. In 31% (n = 18), the LAT was < 10 minutes; in 59% (n = 34), the LAT was > 10 minutes and < 30 minutes; and in 10% (n = 6), the LAT was > 30 minutes. SLN was significantly positive (p = .02) when the LAT was less than 10 minutes and the negative predictive value was 100% for LAT > 30 minutes. A recurrence was significantly observed (p = .02) for LAT < 10 minutes. CONCLUSION: LAT > 30 minutes is associated with negative SLN in head and neck melanoma; however, a prospective study on a more important cohort is needed for a better evaluation of this new variable.

Slow dynamics of lymphoscintigraphic mapping is associated to the negativity of the sentinel node in melanoma patients.

AIMS: To confirm an association between a slow kinetics in the lymphoscintigraphic mapping of the sentinel node (SN), and SN negativity (SN-) in melanoma (MM) patients, and to test whether a long scintigraphic appearance time (SAT) could be a noninvasive surrogate marker of SN-. METHODS: A retrospective cohort of 194 successive MMs with Breslow >/=1.5 mm with follow-up >18 months after SN procedure were retrospectively randomized into two groups: a test sample (T) (two-thirds) to assess the relationship between SN status and lymphoscintigraphy dynamics, and to identify a potential scintigraphic marker of SN-, which was confirmed in the validation sample (V) (one-third). A prospective cohort of 150 consecutive new patients was then used to test the negative predictive value (NPV) of this marker. RESULTS: In sample T, SAT was significantly lower in SN+ than SN- patients (p = 0.04). In a multivariate model, SAT was predictive of SN status, before tumor thickness. SAT was also predictive of disease of disease-free survival (DFS) and overall survival (OS). None of the patients with SAT >30 min (24.8%) were SN+. SAT >30 min was validated as a potential marker for SN- in sample V with NPV = 100% (confidence interval [CI] 84.6-100). In the prospective cohort, the NPV of this marker was however only 84.6% (CI 65.1-95.6). CONCLUSION: Slow SAT is associated with SN- and better survival, which opens interesting hypotheses as to the process of the first nodal metastasis. However, the best possible lymphoscintigraphic marker was not consistent enough to recognize patients in whom the invasive phase of SN biopsy could be avoided.