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David N. Krag, MD; Sybren J. Meijer, MD; Donald L. Weaver, MD; Brian W. Loggie, MD, PA; Seth P. Harlow, MD; Kenneth K. Tanabe, MD; Edward H. Laughlin, MD, PA; James C. Alex, MD

Arch Surg. 1995;130(6):654-658.

Abstract
Objective
To develop a simple, minimally invasive technique of determining whether regional node metastasis has occurred in patients with melanoma.

Setting
Teaching hospital tertiary care and private practice settings.

Patients
Between February 1993 and October 1994, 121 patients with invasive malignant melanoma and clinically negative lymph nodes were enrolled in this clinical trial.

Design
Consecutive sample clinical trial. Within 24 hours prior to lymph node resection, a radioactive tracer was injected into the dermis around the site of the primary melanoma. Forty-four patients also had blue dye injected immediately prior to surgical resection. Measurement of radioactivity in the lymph nodes and surgical localization were made using a handheld gamma detector. Radiolabeled nodes were selectively removed with the least dissection possible. In patients with pathologically positive radiolabeled nodes, regional lymphadenectomy was performed.

Outcome Measures
Successful identification of radiolabeled sentinel lymph nodes, correlation of radiolabeling with injection of blue dye, and regional node recurrence rate.

Results
Surgeons successfully resected the radiolabeled sentinel lymph nodes in 118 (98%) of 121 patients. One hundred percent of blue-stained lymph nodes were successfully radiolabeled. Fifteen patients had pathologically positive sentinel lymph nodes. In 10 patients, the sentinel node was the only node with metastasis. Two systemic and one regional node recurrences occurred during a mean follow-up of 220 days.

Conclusions
Selective gamma probe—guided resection of the radiolabeled sentinel lymph node is possible in over 95% of patients with melanoma. This technique offers a simple and reliable method of staging of regional lymph nodes in these patients without performing a regional lymphadenectomy.

(Arch Surg. 1995;130:654-658)

Author Affiliations
From the Departments of Surgery (Drs Krag, Harlow, and Alex) and Pathology (Dr Weaver), University of Vermont, Burlington; the Department of Surgery, Free University, Amsterdam, the Netherlands (Dr Meijer); the Department of Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC (Dr Loggie); and the Department of Surgery, Massachusetts General Hospital, Boston (Dr Tanabe). Dr Laughlin is in private practice in Huntsville, Ala.

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