Cost Analysis of Sentinel Lymph Node Biopsy as an Alternative to Elective Lymph Node Dissection in Patients with Malignant Melanoma

Brobeil, A; Cw, Cruse; Jl, Messina; Lf, Glass; Ff, Haddad; Cg, Berman; Marshburn, Jan; Ds, Reintgen

doi:10.1016/s1055-3207(18)30195-9

Cited by 35 publications

(25 citation statements)

References 11 publications

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“…3 Sentinel lymph node (SLN) status is the most powerful prognostic indicator for recurrence and survival for individuals diagnosed as having primary melanoma. [4][5][6] With minimal morbidity, SLN biopsy (SLNB; also known as sentinel lymph node dissection [SLND]) reliably detects subclinical nodal involvement, [7][8][9][10] provides accurate and cost-effective 11 staging, and identifies patients who may benefit from standard adjuvant or experimental therapy. 3,12 Whether SLNB confers a survival benefit awaits confirmation from several ongoing clinical trials, 13 including the Multicenter Sentinel Lymphadenectomy Trial, 7 the Sunbelt Melanoma Trial, 14 and the Florida Melanoma Trial.…”

Section: T He Incidence Of Mela-mentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Berk

Johnson²,

Uzieblo³

et al. 2005

Arch Dermatol

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Section: T He Incidence Of Mela-mentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Berk

Johnson²,

Uzieblo³

et al. 2005

Arch Dermatol

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“…Lymphatic mapping definitely provides important prognostic information [82], as shown by an overall 93% 3-year survival in patients with negative sentinel lymph node biopsy versus 67% survival in those with a tumor-positive sentinel node [84,91], the tumor status of the sentinel lymph node is an essential parameter in the new staging system for patients with cutaneous melanoma [17,18,[86][87][88], as either the number or the percentage of metastatic lymph nodes is the strongest predictor of outcome reviewed in [17,18,90,91].…”

Section: Results Clinical Significance and Indications For Sentinelmentioning

confidence: 99%

“…There is a contraindication for patients who have already had a wide excision with or without closure by rotation skin flap, as lymphatic drainage of the primary site can be deeply modified by such surgical procedures. Although patients with primary melanomas between 1 and 4 mm thick arein principle the most likely to benefit from sentinel lymph node biopsy, sentinel node biopsy is soon becoming a required standard of care for staging purposes [17,18,90,91].…”

Section: Results Clinical Significance and Indications For Sentinelmentioning

confidence: 99%

“…Despite some differences in the way radioguided sentinel lymph node biopsy is being performed around the world, the excellent results reported univocally point to this procedure as the most safe, efficient, and costeffective modality for lymphatic mapping in patients with primary cutaneous melanoma [87,[89][90][91] due to the capability of the procedure to actually change surgical management of melanoma patients, by sparing them unnecessarily extensive surgery [92,93].…”

Section: Discussionmentioning

confidence: 99%

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Radioguided sentinel lymph node biopsy in patients with malignant cutaneous melanoma: The nuclear medicine contribution

Mariani

Erba

Manca

et al. 2004

Journal of Surgical Oncology

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As for other solid tumors, malignant cutaneous melanoma drains in a logical way through the lymphatic system, from the first to subsequent levels. Therefore, the first lymph node encountered (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it highly unlikely that other nodes in the same lymphatic basin are affected. Sentinel lymph node biopsy distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of lymphedema, and those with metastatic involvement who might benefit from additional therapy. This procedure represents a significant advantage as a minimally invasive procedure, considering that only an average 20% of melanoma patients with Breslow thickness between 1.5 and 4 mm harbour metastasis in their sentinel node(s) and are therefore candidates to elective lymph node dissection procedures. The cells that originate cutaneous melanomas are located between dermis and epidermis, a zone that drains to the inner lymphatic network in the reticular dermis, in turn to larger collecting lymphatics in subcutis. Therefore, the optimal modality of interstitial administration of radiocolloids for lymphoscintigraphy and subsequent radioguided sentinel lymph node biopsy is through intradermal/subdermal injection. (99m)Tc-labeled colloids in various size ranges are equally adequate for radioguided sentinel lymph node biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas located in the midline area of the head, neck, and trunk, particular consideration should be given to ambiguous lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the sites of the node(s). The sentinel lymph node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in melanoma patients is about 98% in institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. The procedure is becoming the standard of care for patients with cutaneous melanoma because of its high prognostic value that has led to include the procedure in the most recent version of the TNM staging system.

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“…The technique sometimes requires general anesthesia-particularly in the case of neck and/ or axilla lymphatic basin involvement-and is burdened by some postoperative complications such as lymph leakage and delayed wound healing in up to 30% of cases [13]. In addition, it has been estimated that the cost of the procedure ranges between USD 6,000 and 13,000 according to the type of anesthesia employed (i.e., local and general, respectively) [14]. In an attempt to optimize the preoperative staging process in patients with primary CM, the implementation of non-invasive technologies such as US scan may provide some advantages.…”

Section: Introductionmentioning

confidence: 99%