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Open AccessArticle

The Lymphoscintigraphic Study of Unpredictable Head and Neck Cutaneous Melanoma Lymphatic Drainage

1
Nuclear Medicine Unit, Interdisciplinary Department of Medicine–University of Bari “Aldo Moro”, 70124 Bari, Italy
2
Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario “Ernesto Quagliariello”, University of Bari “Aldo Moro”, 70125 Bari, Italy
3
Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 81038 Naples, Italy
4
Interdisciplinary Department of Medicine, section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Piazza Giulio Cesare, 11–70124 Bari, Italy
5
Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
*
Author to whom correspondence should be addressed.
Biomedicines 2020, 8(4), 70; https://doi.org/10.3390/biomedicines8040070
Received: 18 February 2020 / Revised: 3 March 2020 / Accepted: 6 March 2020 / Published: 27 March 2020
Head and neck cutaneous melanoma (HNCM) does not always follow standard lymphatic drainage; typical expected lymphatic pathways are associated with unexpected ones. The aim of this study was to investigate the relation between the primary HNCM sites and all possible lymphatic drainage pathways by lymphoscintigraphy with a special focus on the unexpected sentinel lymph node (SLNs) detection. We retrospectively analyzed 67 patients (46 M, 21 F; mean age 63 years) who underwent lymphoscintigraphy from January 2004 to November 2018. 99mTc-serum albumin was injected intra-dermally at the dose of 18–37 MBq in 0.2–0.4 mL. All patients underwent dynamic and static image acquisition. For all patients, the relation between the expected and unexpected SLNs was performed using the “Sidney Melanoma Unit Database” as our reference. The relation was performed also according to the primary HNCM localization. Cohens’ kappa was calculated. In 61/67 (91%) of patients, SLNs were detected only in predictable sites, while in six/67 (9%), unexpected SLNs were revealed. In all patients, the agreement proportion was 91% (95% confidence interval CI 0.8–0.96) and Cohen’s K was 0.11 (95% CI 0–0.43). Regarding the primary melanoma sites, the nasolabial field HNCM showed the highest rate of concordance (K = 0.60; 95%, CI 0.32–0.89) while the preauricular region HNCM revealed the highest rate of discordance with the clinically predictable drainage. The HNCM lymphatic drainage is extremely variable in regard to both the sites and the number of involved SLNs. The lymphoscintigraphic study is highly recommended to identify all possible SLNs in order to perform an accurate staging for all patients and to avoid missing unexpected SLNs. View Full-Text
Keywords: Head and Neck Cutaneous Melanoma (HNCM); lymphatic drainage; Sidney Melanoma Unit Database; field cancerization Head and Neck Cutaneous Melanoma (HNCM); lymphatic drainage; Sidney Melanoma Unit Database; field cancerization
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MDPI and ACS Style

Lavelli, V.; Ferrari, C.; Santo, G.; Altini, C.; Ballini, A.; Sardaro, A.; Fanelli, M.; Pisani, A.R.; Nappi, A.G.; Giudice, G.; Rubini, G. The Lymphoscintigraphic Study of Unpredictable Head and Neck Cutaneous Melanoma Lymphatic Drainage. Biomedicines 2020, 8, 70.

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