Sentinel lymph node in melanoma: present aspects and future trends

Abstract

In melanoma, the sentinel lymph node (SLN) status is the most important factor determining overall survival. Lymphoscintigraphy is a current practice evolving since more than 20 years. It represents the standard practice in detecting SLN and includes dynamic imaging and SPECT/CT. This article reviews the different technical aspects of lymphoscintigraphy with their advantages. It also reviews the main other ways of SLN imaging in melanoma, including more specific techniques, some of them representing a field of research. A PUBMED (MeSH) search was performed with the following keywords: sentinel lymph node melanoma imaging and reviewed relevant articles. We excluded case reports, publications with an Impact Factor lower than 2 and older than 10 years. The use of dynamic and delayed images combined with preoperative SPECT/CT and blue dye during surgery remains the method of choice in sentinel lymph node melanoma detection. SPECT/CT provides several advantages, in particular a higher rate of node detection, better nodes localization and reduction of operative time, with significantly reducing costs. To provide longer retention in lymphatic nodes, some targeted agents are developed but their clinical use is limited. Lymphatic staging with imaging contrast agents could directly assess nodal status without surgery and could be a promising method for the future.