Detection of Submicroscopic Lymph Node Metastases in Patients With Melanoma

Heller, Richard; Becker, J. C.; Wasselle, Joseph; Baekey, Paul; Cruse, Wayne; Wells, Karen; Cox, Charles E.; King, B S Jeff; Reintgen, Douglas S.

doi:10.1001/archsurg.1991.01410360025005

Cited by 60 publications

(25 citation statements)

References 18 publications

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“…It means only that to the extent the node was examined, the pathologist did not observe cancer cells. More aggressive techniques to identify cancer cells-for example, serial sections, 22 immunohistochemistry, 23 reverse-transcription polymerase chain reaction, 24 and tissue culture 25 -can result in detection of additional cancer cells in nodes that previously were considered free of cancer. The threshold number of cancer cells necessary to initiate clonogenic growth in a lymph node is simply unknown.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Survival According to Number of Nodes Removed

Krag

Single

2003

Ann Surg Oncol

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Background:Results from randomized trials indicate a 5.4% survival advantage associated with axillary dissection. To gain insight on survival outcomes when less than an axillary dissection is performed, we performed a retrospective analysis to determine survival outcome for node-negative and node-positive breast cancer patients when a variable number of nodes were excised.Methods: The data analyzed in this paper are from the Surveillance, Epidemiology, and End Results (SEER) database, from which 72,102 patients were selected whose breast cancer had been diagnosed in 1988 or later and who were aged 40 -79 years at diagnosis, had a single primary lesion, and had 0 to 3 positive lymph nodes. Cases were separated into age groups (40 to 49 and 50 to 79 years), and node-negative cases were separated from those with one to three positive nodes.Results: This analysis indicates that even when all regional lymph nodes are pathologically negative, the number of nodes removed is associated with survival. In the group of breast cancer patients who had one to three pathologically positive nodes, as with the node-negative group, the higher the number of nodes removed, the greater the survival. The hazard rate for death in the node-negative group was roughly 5% less for each additional five nodes removed. For the node-positive group, the hazard rate for death was between 8% and 9% less for each additional five nodes removed.Conclusions: This retrospective study supports the notion that removal of regional nodes, even when such nodes are interpreted as pathologically negative, is important for the long-term survival of breast cancer patients.

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Survival According to Number of Nodes Removed

Krag

Single

2003

Ann Surg Oncol

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“…26,27 Neither of these studies reported clinical follow-up, and currently neither of these techniques is applicable to routine practice.…”

Section: Discussionmentioning

confidence: 99%

A Half a Node or a Whole Node:A Comparison of Methods for Submitting Lymph Nodes

et al. 1998

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“…The human tyrosinase gene is reportedly expressed only in Schwann cells, normal melanocytes, and malignant melanoma cells. 34 After purification of total cellular RNA, complementary DNA (cDNA) fragments of tyrosinase mRNA are made by a RT step in the presence of a specific primer (HTYR2). Two rounds of PCR using nested primer pairs (HTYR1/HTYR2 and HTYR3/HTYR4) then amplify the tyrosinase cDNA.…”

Section: Htyr2mentioning

confidence: 99%

Molecular Staging of Malignant Melanoma

Shivers

Wang²,

Li³

et al. 1998

JAMA

337

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Context.-For most solid tumors, the metastatic status of regional lymph nodes is the strongest predictor of relapse and survival. However, routine pathological examination of lymph nodes may underestimate the number of patients with melanoma who have nodal metastases.Objective.-To determine the clinical significance of a highly sensitive molecular assay for occult nodal metastases for the staging of patients with melanoma.Design.-A prospective cohort study of consecutive patients in which lymphatic mapping and sentinel lymph node (SLN) biopsy were performed on 114 melanoma patients with clinical stage I and stage II disease. The SLNs were bivalved, and half of each specimen was submitted for routine pathological examination. The other half was submitted for molecular detection of submicroscopic metastases using a reverse transcriptase-polymerase chain reaction (RT-PCR) assay for tyrosinase messenger RNA as a marker for the presence of melanoma cells. Patient followup averaged 28 months.Setting.-A major university-based melanoma referral center at a National Cancer Institute-designated cancer center.Patients.-A total of 114 patients with newly diagnosed cutaneous malignant melanoma who were at risk for regional nodal metastases.Main Outcome Measure.-Melanoma recurrence and overall survival.Results.-Twenty-three patients (20%) had pathologically positive SLNs, and all of these patients were also RT-PCR positive. Of the 91 pathologically negative patients, 44 were RT-PCR negative and 47 were RT-PCR positive. There was a recurrence rate among 14 (61%) of the 23 patients who were both pathologically and RT-PCR positive and a recurrence rate among 1 (2%) of 44 patients who were both pathologically and RT-PCR negative. For patients who were upstaged by the molecular assay (pathologically negative, RT-PCR positive), there was a recurrence rate among 6 (13%) of 47 patients. The differences in recurrence rates and overall survival between the pathologically negative, RT-PCR-negative and pathologically negative, RT-PCR-positive patient groups were statistically significant (P = .02 for disease-free survival and for overall survival). In both univariate and multivariate regression analyses, the histological and RT-PCR status of the SLNs were the best predictors of disease-free survival.Conclusions.-The use of an RT-PCR assay for detection of submicroscopic melanoma metastases in SLNs improved the prediction of melanoma recurrence and overall survival over routine pathological examination.

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Detection of Submicroscopic Lymph Node Metastases in Patients With Melanoma

Cited by 60 publications

References 18 publications

Breast Cancer Survival According to Number of Nodes Removed

Breast Cancer Survival According to Number of Nodes Removed

A Half a Node or a Whole Node:A Comparison of Methods for Submitting Lymph Nodes

Molecular Staging of Malignant Melanoma

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