Systematic Review of 99mTc Human Serum Albumin and 99mTc Sulfur Colloid Studies of Sentinel Lymph Node Biopsy of Cutaneous Melanoma of the Head and Neck

Introduction: Sentinel lymph node biopsy (SLNB) of head and neck melanoma presents a technical challenge due to the multiplicity of basins and variable lymph node drainage. Radiotracer size and particulate nature determines speed of lymphatic drainage into nodal basins, as well as nodal uptake and retention. Human serum albumin (HSA) and sulfur colloid (SC) are commonly used radiotracers with divergent chemical characteristics. Results: Eligibility criteria were met for 26 studies (n=2257), 7 prospective and 19 retrospective. Of these, 8 studies (n=422) used HSA and 18 studies (n=1835) used SC. The identification rates of sentinel nodes for HSA and SC were 91.7% and 97.5%, respectively. The false negative rate was 12.5% and 12.2% in HSA and SC, respectively. The median post-test probability negative for nodal recurrence and for total recurrence was 3.9% and 12.6%, and 2.1% and 11.6%, respectively, for HSA and SC. Conclusion Although HSA and SC have different intrinsic chemical properties, both are efficacious for use in SLNB of cutaneous melanoma of the head and neck. METHODS •Systematic literature review from 1990 to 2009 •Dual blind data extraction of articles •Studies analyzed by radiotracer (HSA or SC). •Primary outcomes included: •identification rate •False negative rate based on completion dissection or nodal recurrence •Post test negative probability for nodal recurrence RESULTS Table 1: Systematic review of the literature on SLNB in head and neck cutaneous melanoma yielded 26 studies. * Indicated that data was not available and the article was not used for the analysis of the corresponding test performance indicator. OBJECTIVES •To determine the efficaciousness of HSA and SC in SLNB of cutaneous head and neck melanoma. CONCLUSION •Human serum albumin and sulfur colloid have unique chemical characteristics. •Despite this, both are efficacious in sentinel lymph node biopsy in head and neck cutaneous melanoma. SUMMARY •Identification rates of sentinel nodes using either HSA or SC were 91.7% and 97.5%, respectively. •False negative rates for HAS and SC were 12.5% and 12.2%, respectively. •In a patient with a negative SLNB, the likelihood of nodal recurrence was 3.9% and 12.6% for HSA and SC, respectively. •In a patient with a negative SLNB, the likelihood of recurrence at any site was 2.1% and 11.6% for HSA and SC, respectively. ACKNOWLEDGEMENTS •Department of General Surgery and Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center •Correspondence to Dr. Walter Lee (walter.lee@duke.edu) Cervical nodal groups as described by their anatomic location From Gluckman JL, Johnson JT, eds. Surgical Management of Neck Metastases. London, New York: Martin Dunitz; Independence KY: Distributed in the US by Taylor & Francis; 2003:9. Characteristics of 99m Tc Human Serum Albumin and Sulfur Colloid AUTHOR Year of Study Publication Prospective or Retrospective N Blue dye (Y/N) Tc 99m Radiotracer Immunohistochemistry (Y/N/U) SLN detected (%N) Mean follow‐up (months) False Negative Rate Jansen 2000 Prospective 30 Y HSA Y 90.00 23 20.00% Maffioli 2000 Retrospective 17 Y HSA U 100.00 21 (median) * Koskivuo 2009 Retrospective 25 Y HSA Y 88.00 27 0.00% Doting 2006 Retrospective 36 Y HSA Y 91.67 54 (median) 12.50% Maccauro 2005 Prospective 61 Y HSA Y 98.36 36 4.76% Bostick 1997 Retrospective 117 Y HSA Y * 46 0.00% Teltzrow 2007 Retrospective 106 N HSA Y 88.68 47 32.00% Shpitzer 2004 Prospective 30 Y HSA Y 93.33 31 20.00% Rigual 2007 Retrospective 22 Y SC Y 100.00 35 0.00% Chao 2003 Prospective 321 Y SC Y 100.00 15.5 (median) 12.24% Cole 2003 Retrospective 9 Y SC N 100.00 21 * Alex 1998 Prospective 23 Y SC Y 95.65 30 * Rasgon 2001 Retrospective 27 Y SC Y 85.19 18 * Medina‐Franco 2001 Retrospective 54 Y SC Y 64.81 17 20.00% Macneill 2005 Retrospective 48 Y SC Y 85.42 24 0.00% Eicher 2002 Prospective 43 Y SC Y 97.67 * * Alex 2004 Prospective 43 Y SC Y 97.67 81 * Fincher 2004 Retrospective 51 Y SC Y 100.00 35 0.00% Wagner 2000 Retrospective 70 Y SC Y 100.00 11 7.69% Patel 2002 Retrospective 56 Y SC Y 92.86 20 20.00% Wells 1997 Retrospective 58 Y SC Y 94.83 12 0.00% Schmalbach 2003 Retrospective 87 Y SC Y 88.51 25 17.65% Gomez‐Rivera 2008 Retrospective 113 Y SC Y 100.00 34(median) 17.86% Lin 2006 Restrospective 114 Y SC Y 97.37 7 * Carlson 2005 Retrospective 132 Y SC Y 94.70 35 24.14% Leong 2006 Retrospective 629 Y SC N 97.62 39.6 (median) * Human Serum Albumin Sulfur Colloid Nature Nonparticulate Particulate Particle Size (nm) 4-100 15-5,000 Lymphatic Drainage Rapid Slow