Can sentinel node biopsy be safely omitted in thin melanoma? Risk factor analysis of 1272 multicenter prospective cases

Piazzalunga, Dario; Ceresoli, Marco; Allievi, Niccolò; Ribero, Simone; Quaglino, Pietro; Lorenzo, Sara Di; Corradino, Bartolo; Campana, Luca Giovanni; Mocellin, Simone; Rossi, Carlo Riccardo

doi:10.1016/j.ejso.2018.11.022

Cited by 18 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two recent studies 9,10 indicate that performing SNB based on T1a versus T1b status is problematic. Egger et al 9 showed that not all patients with nonulcerated T1b melanomas should undergo SNB, because age and mitotic rate can identify patients with a , 5% risk of a positive SN, in whom SNB can reasonably be omitted.…”

Section: Discussionmentioning

confidence: 99%

“…Egger et al 9 showed that not all patients with nonulcerated T1b melanomas should undergo SNB, because age and mitotic rate can identify patients with a , 5% risk of a positive SN, in whom SNB can reasonably be omitted. Piazzalunga et al 10 found that, despite a reduction in the proportion of patients with a positive SN in the newly defined pT1a category compared with the old pT1a, 10.71% of those with pT1a disease had a positive SN. These studies indicate that performing SNB based on T1a versus T1b status risks overtreatment or undertreatment in a considerable proportion of patients.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 However, 2 recent reports have suggested that these recommendations carry the risk of overtreatment or undertreatment in many patients with T1 disease. 9,10 Until recently, most SN-positive patients were offered completion lymph node dissection (CLND), because there was evidence that it could improve prognosis. 11 However, the Multicenter Selective Lymphadenectomy Trial II showed that immediate CLND did not improve survival.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram

Maurichi

Miceli

Eriksson

et al. 2020

JCO

Self Cite

View full text Add to dashboard Cite

The authors of the May 10, 2020 article entitled "Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram" (J Clin Oncol 10.1200/JCO.19.01902) have made errors in Figure 1 that affect the accuracy of the nomogram. Since this nomogram may have implications for patient care, JCO has decided to temporarily suspend online publication of this manuscript until this matter has been fully addressed. A corrected version of this manuscript will be made available as soon as possible.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram

Maurichi

Miceli

Eriksson

et al. 2020

JCO

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition to these adverse features, others such as Clark level, regression, and vertical growth phase have been shown to be associated with +SLN in patients with thin melanoma . However, it is unknown whether a combination of these risk factors could identify a group of patients at higher risk of a +SLN for which a SLNB could be justified, and consequently, accurate selection of patients in this population for SLNB remains a challenge …”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making

Friedman¹,

Lyon²,

Torphy³

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Objective: To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates.Methods: Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated.Results: Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cutoff, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria. Conclusions:The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.

show abstract

“…Predictors of sentinel LN status have been extensively studied, identifying younger age, increasing thickness, ulceration, lymphovascular invasion, and mitotic rate to be associated with nodal positivity. [13][14][15][16][17] To the authors' best knowledge, no studies have specifically evaluated characteristics associated with the extent of pathologic nodal burden in patients with cLN metastases. Using multivariable logistic regression, preoperative imaging was identified to be strongly associated with pathologic outcome.…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with Pathologic Nodal Burden in Patients Presenting with Clinical Melanoma Nodal Metastasis

et al. 2019

View full text Add to dashboard Cite

Background-Nodal observation is safe for patients with microscopic melanoma metastasis in a sentinel lymph node (LN). Complete LN dissection (CLND) remains the standard of care for patients with clinically evident LN (cLN) metastases, even though about 40% have only one pathologic LN (pLN). We sought to identify clinical features associated with having one pLN among patients with cLNs. Methods-Patients at three melanoma centers who underwent CLND for cLNs were identified. Clinicopathologic and imaging characteristics associated with one pLN were determined by multivariable logistic regression and classification tree analysis. Results-Of 190 patients, 90 (47.4%) had one pLN and 100 (52.6%) had more than one pLN. By multivariable logistic regression, extremity versus truncal primary (odds ratio [OR] 2.15, p = 0.012), axillary versus superficial inguinal location (OR 3.89, p = 0.009), and preoperative crosssectional imaging demonstrating more than one versus one cLN (OR 17.1, p < 0.001) were associated with more than one pLN. The negative predictive value for additional pathologic nodal disease of preoperative imaging was 70.9%, increasing to 74.4% for positron emission tomography/computed tomography. In the subgroup of patients with one cLN, the classification tree identified two groups with < 10% risk of additional pLNs: (1) Breslow thickness > 6.55 mm

show abstract

Can sentinel node biopsy be safely omitted in thin melanoma? Risk factor analysis of 1272 multicenter prospective cases

Cited by 18 publications

References 19 publications

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram

A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making

Characteristics Associated with Pathologic Nodal Burden in Patients Presenting with Clinical Melanoma Nodal Metastasis

Contact Info

Product

Resources

About