McGregor Andrew, Pavri Sabrina N, Kim Samuel, Xu Xiaolu, Narayan Deepak
Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn.; and Yale University School of Medicine, New Haven, Conn.
Plast Reconstr Surg Glob Open. 2018 Mar 6;6(3):e1681. doi: 10.1097/GOX.0000000000001681. eCollection 2018 Mar.
Preoperative lymphoscintigraphy (LSG) is an imaging procedure routinely used to identify the draining nodal basin in melanomas. At our institute, we have traditionally performed preoperative LSG followed by intraoperative LSG for logistical and evaluative reasons. We sought to determine if preoperative LSG could be safely eliminated in the treatment of extremity melanomas, which exhibit consistent and predictable lymphatic drainage patterns.
We reviewed the Yale Melanoma Registry 1308012545 for cutaneous extremity melanomas treated at our institution. From this registry, we calculated the incidence of atypical lymph node drainage patterns outside the axillary and inguinal regions. Based on these data, we eliminated preoperative LSG in 21 cases (8 upper extremities and 13 lower extremities). Additionally, we calculated the potential hospital charge reduction of forgoing preoperative LSG.
Upper and lower extremity melanomas treated at our institution exhibited atypical lymph node drainage at a rate of 3.4% and 2.0%, respectively. The sites of atypical drainage were to the epitrochlear and popliteal regions. In all 21 cases where preoperative LSG was eliminated, we were able to correctly identify the sentinel lymph node. The potential hospital charge reduction of forgoing preoperative LSG totaled $2,393.
Preoperative LSG can be safely eliminated in the management of upper and lower extremity melanomas. Exceptions may be considered for primary lesions of the posterior calf, ankle, and heel as well as for patients with history of prior surgery or radiation. Forgoing preoperative LSG results in a hospital charge reduction of $2,393 and provides additional benefits to the patient. Ultimately, there is potential for significant charge reduction if applied across health care systems.
术前淋巴闪烁显像（LSG）是一种常用于识别黑色素瘤引流淋巴结区域的成像检查。在我们研究所，出于后勤和评估方面的原因，我们传统上会在术前进行LSG，然后再进行术中LSG。我们试图确定在治疗具有一致且可预测淋巴引流模式的肢体黑色素瘤时，能否安全地省去术前LSG。
我们查阅了耶鲁黑色素瘤登记处中在我们机构接受治疗的肢体皮肤黑色素瘤病例。从该登记处，我们计算了腋窝和腹股沟区域以外非典型淋巴结引流模式的发生率。基于这些数据，我们在21例病例（8例上肢和13例下肢）中省去了术前LSG。此外，我们计算了省去术前LSG可能带来的医院费用减少情况。
在我们机构接受治疗的上肢和下肢黑色素瘤分别有3.4%和2.0%出现非典型淋巴结引流。非典型引流部位为滑车上和腘窝区域。在省去术前LSG的所有21例病例中，我们都能够正确识别前哨淋巴结。省去术前LSG可能带来的医院费用减少总计2393美元。
在治疗上肢和下肢黑色素瘤时，可以安全地省去术前LSG。对于小腿后部、脚踝和足跟的原发性病变以及有既往手术或放疗史的患者，可考虑为例外情况。省去术前LSG可使医院费用减少2393美元，并为患者带来额外益处。最终，如果在整个医疗系统中应用，有可能大幅降低费用。
