Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma

Doting, M. H. E.; Hoekstra, H.J.; Plukker, John; Piers, Da; Jager, PL; Tiebosch, A.T.M.G.; Vermey, A; Koops, H. Schraffordt

doi:10.1053/ejso.2002.1297

Cited by 71 publications

(28 citation statements)

References 32 publications

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“…11 Amongst other investigators, we have found comparable results in earlier studies: in line with other studies using this definition and an earlier report from our hospital the false-negative rate in the current study is 11%. 3,12 Remarkably, however, the false-negative rate recently dropped to 2% in our center. Recently data from the Sunbelt Melanoma Trial by Scoggins et al show no OS difference between patients with a false-negative SLN and patients with a true-positive SLN result.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 58%

“…The SLNB procedure at our institution has been described in detail previously. 3 Excision specimens were sent for routine histopathological analysis with haematoxylin-eosin (HE) staining.…”

Section: Slnb Techniquementioning

confidence: 99%

“…3 The aim of the study was to gain insight in the long-term results of the SLNB staging procedure regarding detection, complication rates, patient survival rates and prognostic factors using the 7 th American…”

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma

Vries¹,

Speijers²,

Bastiaannet³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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, et al.. Long-term followup reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma. EJSO -European Journal of Surgical Oncology, WB Saunders, 2011, 37 (8) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 124 Patients (29%) relapsed during follow-up; 55 in the node-positive group who underwent CLND (55/119;46%) and 69 in the node-negative group (69/310;22%;p<0.001). In the node-negative group 17 patients developed recurrence in the regional node field; false-negative rate 11%.On multivariate analysis strongest prognostic factors for disease free survival (DFS) were primary melanoma ulceration and SLN positivity (Hazard Ratio (HR) of 2.2 and 2.3; p<0.001). For disease specific survival (DSS) the same was found to be true with a HR of 2.1 for ulceration and 2.0 for SLN positivity (p=0.001 and p=0.002 respectively). 10-Year DFS was 71% for node-negative patients compared with 48% for node-positive patients (p<0.001). 10-Year DSS was 77% for node-negative patients compared to 60% for node-positive patients (p<0.001).Conclusions: This study shows a remarkably high percentage of tumor-positive SLN. The long-term follow-up data confirm that tumor-positive SLN patients have a worse DFS and DSS than tumornegative SLN patients. Ulceration and SLN status proved to be the strongest prognostic factors for long-term DFS and DSS.

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Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 58%

“…The SLNB procedure at our institution has been described in detail previously. 3 Excision specimens were sent for routine histopathological analysis with haematoxylin-eosin (HE) staining.…”

Section: Slnb Techniquementioning

confidence: 99%

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Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma

Vries¹,

Speijers²,

Bastiaannet³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…Rates of false-negative results in melanoma presently are about 10% (24)(25)(26). The lack of standard adjuvant therapy for melanoma could explain the difference between this disease and breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Visualization of Tumor Blockage and Rerouting of Lymphatic Drainage in Penile Cancer Patients by Use of SPECT/CT

Leijte¹,

Ploeg²,

Olmos³

et al. 2009

J Nucl Med

111

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The reliability of sentinel node biopsy is dependent on the accurate visualization and identification of the sentinel node(s). It has been suggested that extensive metastatic involvement of a sentinel node can lead to blocked inflow and rerouting of lymph fluid to a ''neo-sentinel node'' that may not yet contain tumor cells, causing a false-negative result. However, there is little evidence to support this hypothesis. Recently introduced hybrid SPECT/ CT scanners provide both tomographic lymphoscintigraphy and anatomic detail. Such a scanner enabled the present study of the concept of tumor blockage and rerouting of lymphatic drainage in patients with palpable groin metastases. Methods: Seventeen patients with unilateral palpable and cytologically proven metastases in the groin underwent bilateral conventional lymphoscintigraphy and SPECT/CT before sentinel node biopsy of the contralateral groin. The pattern of lymphatic drainage in the 17 palpable groin metastases was evaluated for signs of tumor blockage or rerouting. Results: On the CT images, the palpable node metastases could be identified in all 17 groins. Four of the 17 palpable node metastases (24%) showed uptake of radioactivity on the SPECT/CT images. In 10 groins, rerouting of lymphatic drainage to a neo-sentinel node was seen; one neo-sentinel node was located in the contralateral groin. A complete absence of lymphatic drainage was seen in the remaining 3 groins. Conclusion: The concept of tumor blockage and rerouting was visualized in 76% of the groins with palpable metastases. Precise physical examination and preoperative ultrasound with fine-needle aspiration cytology may identify nodes with considerable tumor invasion at an earlier stage and thereby reduce the incidence of false-negative results.

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“…Lymphoscintigraphy can demonstrate multiple lymph drainage basins for melanomas located around the watershed areas (midline and umbilicus level) and, moreover, can review all other lymphatic drainage to disclose any interval SNs. The incidence of interval SNs varies widely, from 3.1% to 9.8% (Table 2) (11)(12)(13)(14)(15)(16)(17)(18)(19). We observed interval nodes in 4.5% of cases.…”

Section: Incidence and Anatomymentioning

confidence: 58%

The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients

Matter

Lalonde²,

Allaoua³

et al. 2007

Journal of Nuclear Medicine

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In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This study aimed to review the incidence, lymphatic anatomy, and metastatic risk of interval SNs. Methods: SN biopsy was performed at a tertiary center by a single surgical team on a cohort of 402 consecutive patients with primary melanoma. The triple technique of localization was used-that is, lymphoscintigraphy, blue dye, and g-probe. Otolaryngologic melanoma and mucosal melanoma were excluded from this analysis. SNs were examined by serial sectioning and immunohistochemistry. All patients with metastatic SNs were recommended to undergo a radical selective lymph node dissection. Results: The primary locations of the melanomas included the trunk (188), an upper limb (67), or a lower limb (147). Overall, 97 (24.1%) of the 402 SNs were metastatic. Interval SNs were observed in 18 patients, in all but 2 of whom classic SNs were also found. The location of the primary was truncal in 11 (61%) of the 18, upper limb in 5, and lower limb in 2. One patient with a dorsal melanoma had drainage exclusively in a cervicoscapular area that was shown on removal to contain not lymph node tissue but only a blue lymph channel without tumor cells. Apart from the interval SN, 13 patients had 1 classic SN area and 3 patients 2 classic SN areas. Of the 18 patients, 2 had at least 1 metastatic interval SN and 2 had a classic SN that was metastatic; overall, 4 (22.2%) of 18 patients were node-positive. Conclusion: We found that 2 of 18 interval SNs were metastatic: This study showed that preoperative lymphoscintigraphy must review all known lymphatic areas in order to exclude an interval SN.

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Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma

Cited by 71 publications

References 32 publications

Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma

Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma

Visualization of Tumor Blockage and Rerouting of Lymphatic Drainage in Penile Cancer Patients by Use of SPECT/CT

The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients

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