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J Plast Reconstr Aesthet Surg. 2014 Mar;67(3):316-9. doi: 10.1016/j.bjps.2013.11.008. Epub 2013 Nov 20.

Hot or not? The 10% rule in sentinel lymph node biopsy for malignant melanoma revisited.

Author information

  • 1St. George's Melanoma Unit, Dept. of Plastic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK. Electronic address: Adrian.murphy@mac.com.
  • 2Dept. of Medical Physics, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
  • 3St. George's Melanoma Unit, Dept. of Plastic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.

Abstract

BACKGROUND:

The surgeon needs a practical rule to follow when deciding whether to excise a lymph node during sentinel node biopsy (SLNB). The "10% rule" dictates that all nodes with a radiation count of greater than 10% of the hottest node and all blue nodes should be removed, and this study observes the effects of following this rule in SLNB in melanoma.

METHODS:

We reviewed the records of 665 patients with primary melanoma who underwent sentinel lymph node over a 5-year period (2007-2011).

RESULTS:

2064 nodes were identified in 898 nodal basins in 665 patients. 141 (21%) patients had at least one positive sentinel node. 105 positive nodal basins were identified in which more than one sentinel node was removed. In 18 of these, a less radioactive node was positive for tumour when the most radioactive node was negative. Of 175 positive nodes 157 (90%) contained blue dye staining. For cases in which the positive sentinel node was not the hottest node, the positive node had apparent blue dye staining in all 18 cases (100%), and was the second hottest node in the basin.

CONCLUSION:

In this series removing just the hottest node and all blue nodes would not have missed a single positive basin and would have resulted in a 38% reduction in the number of nodes removed compared to those taken following the 10% rule, without changing the staging in any patient.

Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:

Melanoma; Sentinel node; Staging

PMID:
24290978
[PubMed - indexed for MEDLINE]
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