To evaluate the feasibility of sentinel node staging for detection ofoccult regional lymph node metastasis in high-risk cutaneous nonmelanoma malignancies.
Consecutive clinical case series.
Referral university medical center.
A consecutive sample of patients with a variety of high-risk nonmelanomacutaneous malignancies without evidence of regional lymph node metastases.
Sentinel node biopsies were performed using preoperative lymphoscintigraphy,blue dye, and intraoperative radiolocalization.
Main Outcome Measure
Sensitivity, determined by comparing the results of biopsy specimenevaluation with those of completion lymphadenectomy and/or clinical follow-up.
Twenty-four patients underwent sentinel node biopsy for the stagingof 29 nodal basins identified by lymphoscintigraphy. Primary diagnoses weresquamous cell carcinoma (n = 17), Merkel cell carcinoma (n = 5), and adenocarcinoma(n = 2). Seven patients (29%) had a tumor-positive sentinel node. Sentinelnode biopsy followed by complete lymphadenectomy was performed in 12 patientsand sentinel node biopsy alone in 12 patients. Tumor-positive lymph nodeswere noted in 8 patients, 7 of whom also had positive sentinel nodes. Therewas 1 false-positive result (1/8 [12%]), in a patient with recurrent squamouscell carcinoma of the scalp. At a median follow-up of 10 months, no recurrencesin a sentinel node–negative basin have been noted. Compared with allinformation, the sensitivity of sentinel node staging was 88% and the negativepredictive value was 0.94.
Sentinel node biopsy is a minimally invasive staging procedure usefulin identifying occult regional lymph node disease in selected patients withnonmelanoma cutaneous malignancies. Further studies to verify these findingsand develop formal guidelines are indicated.