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Comparing Rates of Metastatic Node Detection and Regional Recurrence in Patients Undergoing Sentinel Lymph Node Excision With Preoperative SPECT/CT
William B. Albright, MD, Brad Morrow, MD, Donald R. Mackay, MD, Rogerio I. Neves, MD.
Penn State University Hershey Medical Center, Hershey, PA, USA.

PURPOSE: Sentinel lymph node excision (SLNE) with preoperative single-photon emission computed tomography/computed tomography (SPECT/CT) for malignant melanoma was recently shown to be associated with a higher rate of disease-free survival and higher frequency of metastatic involvement when compared to preoperative lymphoscintigraphy alone. Our objective was to corroborate these recently published findings, specifically, metastatic node detection and regional recurrence rates in patients undergoing SLNE with preoperative SPECT/CT, and to identify factors associated with disease-free survival.
METHODS: A retrospective database of 160 clinically node negative patients who underwent SLNE with preoperative SPECT/CT for melanoma at a tertiary care center between May 2009 and October 2011 was created, and included data on patient demographics, biopsy characteristics, imaging findings, surgical details, and oncologic outcomes.
RESULTS: The average patient follow up was 470 days (median [SD], 440 [290] days). Our patient population was similar to the published reference group in regards to demographics (number of patients, age, and gender distribution), and primary pathology characteristics (percent of patients with a positive SLNE and incidence of primary ulceration). Our population had a higher incidence of primary disease located in the head/neck, and lower incidence of disease in the torso. Forty-six of 160 patients had positive SLNs (27.5%) and the number of positive SLNs per patient was 0.35, which mirrors that of the reference group. Eleven patients developed regional lymph node recurrences (ten of who had a positive SLNE). Only a single patient developed regional lymph node recurrence after a negative SLNE. This produced a slightly lower false-negative SLN rate of 2.1% compared to the reference. We are currently performing statistical analysis to evaluate the association between clinical variables and disease-free survival.
CONCLUSION: Our data coincide with recently published metastatic node detection and regional lymph node recurrence rates in patients undergoing SLNE with preoperative SPECT/CT for malignant melanoma.


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