Pathologic examination of the sentinel lymph node in melanoma.

The techniques of lymphatic mapping and sentinel lymph node biopsy are effective methods of accurately staging melanoma patients and identifying those who may benefit from further surgery or adjuvant chemotherapy. This article describes a standard pathology protocol for examination of sentinel lymph nodes in melanoma. Details of this standardized lymph node examination, institutional results using the protocol, and a literature review concerning lymph node findings in malignant melanoma are included.

Lymphoscintigraphy in malignant melanoma and breast cancer.

Lymphoscintigraphy is the injection of radioactive particles that are then imaged as they pass through lymphatic vessels to their respective lymph nodal drainage basins. Lymphoscintigraphy is receiving increasing interest as a means to stage regional lymph nodes in early stage malignancy. Injection and imaging techniques for performing breast and melanoma lymphoscintigraphy are discussed in this article.

Molecular staging for melanoma and breast cancer.

Despite increased sensitivity of PCR techniques, routine H&E histology and, in some cases, immunohistochemistry remain the gold standards for the detection of micrometastatic disease. Highly sensitive and specific molecular assays such as RT-PCR provide an ideal way to detect micrometastatic disease in tissues or blood at risk for metastases. RT-PCR has been shown to increase detection of micrometastases, especially in patients with breast cancer and melanoma. These assays have the potential to provide valuable tumor staging and progression information and thus determine the need for further surgery, adjuvant chemotherapy, and antigen-specific immunotherapy. As investigators gain more experience using molecular assays, the results of these assays will be more likely to guide clinical staging and decision making.

Magnetic resonance imaging of the breast.

BACKGROUND: Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of invasive breast cancer. In clinical studies, breast MRI has often altered the course of patient care. Although promising results have been generated, MRI of the breast is currently in a development stage. METHODS: The authors reviewed the literature on the potential indications, sensitivity, specificity, and limitations of MRI of the breast. RESULTS: Reported advantages of MRI of the breast over conventional imaging techniques include improved staging and treatment planning, enhanced evaluation of the augmented breast, better detection of recurrence, and improved screening of high-risk women. Contrast-enhanced breast MRI is a sensitive modality for detecting breast cancer, but its variable specificity is a major limitation. CONCLUSIONS: MRI of the breast is emerging as a valuable adjunct to mammography and sonography for specific clinical indications. Additional clinical studies that define indications, interpretation criteria, imaging parameters, and cost effectiveness are needed. A multi-institutional study designed to address these issues is in progress.