![]() We divided dual-basin drainage cases into two groups. Therefore, if we can detect the basin with higher lymphatic flow before surgery, we can omit biopsy of the minor basin, reducing the operation time and complication rate. We assumed that metastasis would occur first in the basin that has higher lymphatic flow. In cases of parallel or mixed drainage, the two basins will show similar radioactivity. In such cases, the popliteal area can be regarded as an SLN and a biopsy can be performed in only the popliteal area. If we classify the lymphatic drainage patterns according to the amount of radioactivity measured by a gamma probe during the operation, the amount measured in the popliteal area would be remarkably high in cases of serial drainage. However, the results of lymphoscintigraphy do not always correspond to one of the three lymphatic drainage patterns. In the third pattern, the serial and parallel drainage are mixed, so the inguinal basin can be a first- or second-order basin. In the second pattern, both popliteal and inguinal basins are first-order sentinel node, so two or more lymphatic channels drain into each basin. First, the popliteal basin is an in-transit node, so the single lymphatic channels drain serially to the popliteal area and continue to the inguinal region. Several studies have explained at least three distinct patterns of lymphatic drainage to the popliteal basin. A P-value < 0.05 was considered statistically significant.Īlmost all melanomas with popliteal drainage also had concurrent inguinal drainage. Student t-test and Pearson chi-square analysis were used to compare patient characteristics, and survival rates were calculated using the Kaplan-Meier method. 22.0, IBM Corp., Armonk, NY, USA) for statistical evaluation. Chest and abdominopelvic computed tomography scans were also performed every 6 months or 1 year to detect recurrence during the follow-up period. Physical examination and ultrasonography around the inguinal region and primary tumor site were performed. The patients visited the outpatient clinic every 6 months for the first 5 years and annually thereafter. Complete lymph node dissection (CLND) was performed for all tumor-positive basins. If the two basins showed similar radioactivity, biopsy was performed for both. In the case of dual-basin (inguinal and popliteal) drainage, we regarded the basin showing two times or greater radioactivity value than the other as the ‘dominant’ basin, and SLN biopsy was performed only in the dominant basin. A handheld gamma probe (NEO2000, Neoprobe Co., Dublin, OH, USA) was used to detect SLNs during the operation. This study aimed to analyze clinical outcomes and feasibility of SLN biopsies in lower extremity melanomas with dual-basin drainage on lymphoscintigraphy.Īll patients underwent subcutaneous injection of technetium 99-phytate 2 mCi around the primary tumor on the morning of the surgery, followed by 30-minute continuous imaging and delayed whole body imaging ( Fig. Dual-basin drainage is rare in melanoma patients as a result, literature concerning popliteal SLNs and their management is limited. Almost all melanomas with popliteal drainage show concurrent drainage to inguinal basin. ![]() Sometimes, SLNs are detected in unexpected areas, such as the internal mammary nodes in breast cancer and the popliteal lymph nodes in distal lower extremity melanoma cases. Lymphoscintigraphy is performed prior to surgery to identify the location and number of SLNs. The current standard of care for melanomas that are clinically node negative is wide local excision of the primary tumor and sentinel lymph node (SLN) biopsy for regional nodal staging. ![]() According to data from the Korea Central Cancer Registry, it accounts for 0.3% of total cancer incidence in Korea as of 2014. Melanoma is a skin cancer that rarely occurs in Asian countries.
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