Staging is critical in the management of cancer. Sentinel lymph node (SLN) biopsy is one method used in the assessment of cancer spread. SLN procedures are standard practice in the management of some cancers although; these procedures have only recently been developed and refined. SLN procedures are commonly used in the management of melanomas and breast cancers in patients with no evidence of metastatic disease on clinical exam. SLN procedures include detection, localization, and assessment of SLNs. The detection/localization components vary in technique and rates of success. The procedures with the least number of detection/localization techniques generally include the use of blue dye or the use of a radiotracer with intraoperative gamma counting. The most complex procedures involve the use of blue dye, the use of a radiotracer with preoperative gamma imaging and preoperative gamma counting, intraoperative gamma counting, or some combination of these techniques. The ideal procedure for SLN would include all the listed techniques however; all facilities do not incorporate the most complete procedure, for different reasons. An investigation using a small FOV (5 in x 5 in) gamma camera intraoperatively for SLN procedures in melanoma and breast cancer patients was performed. A smaller FOV camera is capable of obtaining some of the same information as a conventional gamma camera. It is possible that centers, which do not or are not able to take advantage of preoperative imaging, may find the use of a smaller FOV gamma camera in the operating room useful. The investigation consisted of a total of 41 patients; it was split into two studies, Study 1: melanoma and study 2: breast cancer. The melanoma study found the added use of a smaller FOV camera under the parameters of this study to be minimal. Study 2 was broken into two branches; branch 1: camera/probe/dye and branch 2: probe/dye, for a comparison study. Comparing the two branches did not show the smaller FOV camera to reduce the time spent in the operating room versus using the probe and blue dye.

Orientador: Antônio José Maria Cataneo / Resumo: Introdução: No melanoma primário, a aplicabilidade da biópsia de linfonodo sentinela (BLS), seguida ou não de esvazimento linfonodal (EL) é conhecida. Na recidiva locorregional (RL) de melanoma, alguns serviços tendem a indicá-la, buscando estadiamento mais acurado para embasar condutas individualizadas aos pacientes, ainda que as evidências sejam insuficientes. Objetivo: Avaliar o sucesso da BLS no encontro do linfonodo sentinela (LNS) e sua positividade na RL. Comparar a sobrevida entre os pacientes com LNS positivo e negativo. Verificar diferença na sobrevida pós EL. Métodos: Revisão sistemática, através das bases MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE e CENTRAL, buscando estudos experimentais e observacionais sobre BLS na RL de melanoma. Desfechos avaliados: sucesso na BLS pelo encontro do LNS, positividade para melanoma no LNS; sobrevida no subgrupo LNS positivo comparado com o negativo; sobrevida livre de doença no subgrupo LNS positivo comparada com o negativo; sobrevida dos pacientes submetidos ao EL. Para metanálises, utilizaram-se RevMan 5.3 e StatsDirect 3.0.121. Resultados: Foram identificados 1872 estudos, destes, seis estudos observacionais foram incluídos, totalizando 449 pacientes. O LNS foi encontrado em 98% das BLS (IC 95-100%, I2=53,7% - seis estudos). LNS com 32% de positividade para melanoma (IC 19-47%, I2= 84,6% - seis estudos). A chance de sobrevida global em cinco anos foi 2,49 vezes maior no subgrupo com LNS negativo (IC 95% 1,41-4,38, I2=0% - qua... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: In primary melanoma, the applicability of sentinel lymph node biopsy (SLB), followed or not by complete lymph node dissection (CLND) is known. In locoregional recurrence (LR) of melanoma, some groups may indicate it for more accurate staging to support individualized management, even with scarce evidence. Objective: To evaluate success in SLB and its positivity in LR. Compare survival between patients with positive and negative sentinel lymph node (SLN). Check for survival modification after CLND. Methods: Systematic review through databases such as MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE and CENTRAL, searching for experimental and observational studies on SLB in melanoma LR. Outcomes assessed: success in SLB by finding the SLN, positivity for melanoma in the SLN; survival in the positive SLN subgroup compared to the negative one; disease-free survival in the positive versus negative SLN subgroup; survival of patients undergoing CLND. For meta-analyzes, RevMan 5.3 and StatsDirect 3.0.121 were used. Results: The total number of patients in six observational studies was 449, over 1872 studies indentified. The SNL was found in 98% of SLB (95-100% CI, I2 = 53.7%, 6 studies). SLB detected 32% positivity for melanoma on SNL (CI 19-47%, I2 = 84.6%, 6 studies). The chance of five year overall survival was 2,49 higher in the negative SNL subgroup (95% CI 1.41-4.38, I2 = 0%, 4 studies). Meta-analyzes were not performed due to lack of objective data for disease-free survi... (Complete abstract click electronic access below) / Doutor