Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms

PURPOSE Regional lymph node involvement is the most important prognostic indicator in patients with solid tumors. Conventional lymph node dissection has not b een shown to affect survival and is often associated with considerable morb idity. Intraoperative lymphatic mapping and sentinel lymph node dissection were therefore designed as a minimally invasive alternative to routine elec tive lymph node dissection in patients with primary cutaneous melanoma. Thi s study examined whether intraoperative lymphatic mapping and sentinel lymp h node dissection were accurate in staging patients with other solid malign ancies. PATIENTS AND METHODS Between 1985 and 1998, 107 patients with breast cancer, 17 with thyroid tum ors, 14 with gastrointestinal/gynecologic cancers, six with Merkel cell can cers, and five with squamous cell carcinomas of the head and neck have unde rgone mapping and sentinel lymph node dissection at the John Wayne Cancer I nstitute. RESULTS The sentinel node was identified in 96% of patients (38% melanoma). In 36% of patients the sentinel node was the only tumor-positive node (71% melanoma). Eighteen percent of sentinel nodes were negative by h ematoxylin and eosin staining but were positive by immunohistochemical stai ning (15% melanoma). II CONCLUSION These data suggest that many solid neoplasms have a primary lymphatic chann el and lymph node to which it drains. Although sentinel lymph node dissecti on has been popularized in melanoma therapy, we have found it feasible for treatment of other solid malignancies. This technique may ultimately replac e conventional dissection with more accurate staging.