The article by Jacobs et al attempts to establish reasonable parameters for conducting SLN biopsy in patients with cutaneous melanoma. Their data and numerous other reported series point to components of the technique that are not clearly defined. The authors' experience demonstrating that histologically positive SLNs are not always the hottest radioactive SLNs removed is an observation that has been previously documented.1- 3 The sample size of 134 sentinel lymph node biopsy procedures reported in the article is underpowered if one wishes to critically address the issue of which radioactive SLNs need to be removed. Additionally, there is an absence of data to support the conclusion that SLN biopsy requires removal of all nodes containing isotope regardless of the relative magnitude of counts and the supposition that use of blue dye will salvage those procedures in which isotope mapping fails.
Tyler DS, Seigler HF. High Isotope Counts and Sentinel Node Positivity in Patients With Melanoma—Invited Critique. Arch Surg. 2003;138(1):67. doi:10.1001/archsurg.138.1.67