Real-World Adherence to Nodal Surveillance for Sentinel Lymph Node-Positive Melanoma

Montgomery, Kelsey B.; Correya, Tanya; Broman, Kristy Kummerow

doi:10.1245/s10434-022-11839-z

Cited by 12 publications

(10 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CT, MRI).5 Most treatment centres and SLNB-positive patients opt for active surveillance over CLND, without significant differences in recurrence rates. [6][7][8] Our findings suggest that while nodal US demonstrates high specificity in detecting regional recurrence, false positive findings are problematic, with clinical utility also limited by variability in radiologic protocols/interpretation and poor patient adherence to additional imaging. Routine cross sectional imaging for stage III patients with PET-CT, though far costlier than US, revealed comparable nodal findings in our cohort; comparable data were not available for nodal recurrence detected via CT chest/abdomen/ pelvis.…”

mentioning

confidence: 86%

“…For SLNB‐positive CM, current NCCN guidelines recommend clinical observation without additional nodal surgery, but with mandatory radiographic nodal surveillance that includes nodal basin US surveillance (when radiologic expertise is available), or other imaging modalities (e.g. CT, MRI).5 Most treatment centres and SLNB‐positive patients opt for active surveillance over CLND, without significant differences in recurrence rates 6–8 …”

Section: Regional Nodal Recurrences (N = 4)mentioning

confidence: 99%

See 1 more Smart Citation

Nodal ultrasound for regional recurrence detection in sentinel lymph node biopsy‐positive cutaneous melanoma patients undergoing cross‐sectional imaging

Gyurdzhyan,

Muralidharan,

Liu

et al. 2023

Skin Health and Disease

View full text Add to dashboard Cite

Dear Editor, There are limited data comparing the efficacy of ultrasound (US) to cross-sectional imaging (computed tomography [CT], positron emission tomography [PET]-CT, or magnetic resonance imaging [MRI]) for detection of regional nodal recurrence in sentinel lymph node (SLN) biopsy-positive (SLNB-positive) cutaneous melanoma (CM) patients who forego completion lymph node dissection (CLND). 1,2 The seminal MSLT-2 and DeCOG-SLT trials for SLNB-positive patients who underwent nodal US surveillance over CLND focused primarily on relapse free-and melanoma-specific survival, rather than radiographic detection of regional nodal recurrence, and they predated the advent of effective adjuvant therapy. 3,4 While CM guidelines promote active surveillance with nodal US or other imaging over CLND, 5 considerable variability exists in the United States regarding choice of imaging modality, patient adherence to nodal US schedules, 2,6 as well as radiologic criteria and expertise for nodal US detection of regional recurrence, with centres often relying on clinical lymph node examination and standard cross-sectional imaging (CT or PET-CT). Herein, we report our institutional experience of active nodal US surveillance and cross-sectional imaging in a cohort of SLN-positive patients who did not undergo CLND.Following IRB approval, we retrospectively identified SLN-positive patients ≥18 years of age from June 2011 through December 2019, who underwent nodal US surveillance in lieu of CLND and were followed for a minimum of 2 years or until recurrence/metastasis/ death, through June 2022. Clinical, pathological, and radiologic details were collected (Table 1). Primary endpoints were US detection of regional nodal recurrence in comparison to clinical exam and/or crosssectional imaging (PET-CT or CT). US schedule adherence was defined as ≥1 exam every 6 months, inThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

show abstract

mentioning

confidence: 86%

Section: Regional Nodal Recurrences (N = 4)mentioning

confidence: 99%

Nodal ultrasound for regional recurrence detection in sentinel lymph node biopsy‐positive cutaneous melanoma patients undergoing cross‐sectional imaging

Gyurdzhyan,

Muralidharan,

Liu

et al. 2023

Skin Health and Disease

View full text Add to dashboard Cite

show abstract

“…However, more recent research has found that simple ultrasound surveillance and followup of the lymphatic basin is often sufficient to monitor disease progression while avoiding the unwanted consequences of CLND, although pragmatic challenges remain. 3 SLN assessment is indicated for melanomas with Breslow tumour thickness > 1.0 mm. SLN biopsy (SNLB) in lesions with Breslow thickness 1.0 mm or less is considered in selected cases.…”

Section: Introductionmentioning

confidence: 99%

“…Previously the identification of a positive SLN was used to reflex to dissection of the entire lymphatic basin connected to the SLN, also known as completion lymph node dissection (CLND), with the aim to eliminate the tumour before systemic dissemination. However, more recent research has found that simple ultrasound surveillance and follow‐up of the lymphatic basin is often sufficient to monitor disease progression while avoiding the unwanted consequences of CLND, although pragmatic challenges remain 3 …”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node assessment in melanoma: current state and future directions

2023

View full text Add to dashboard Cite

Assessment of sentinel lymph node status is an important step in the evaluation of patients with melanoma for both prognosis and therapeutic management. Pathologists have an important role in this evaluation. The methodologies have varied over time, from the evaluation of dimensions of metastatic burden to determination of the location of the tumour deposits within the lymph node to precise cell counting. However, no single method of sentinel lymph node tumour burden measurement can currently be used as a sole independent predictor of prognosis. The management approach to sentinel lymph node‐positive patients has also evolved over time, with a more conservative approach recently recognised for selected cases. This review gives an overview of past and current status in the field with a glimpse into future directions based on prior experiences and clinical trials.

show abstract

“…The results of these landmark studies have changed clinical practice, and CLND is no longer the standard of treatment in all melanoma patients with involved lymph nodes without distant metastases (stage III). These changes coincided with the increasingly important role of adjuvant systemic therapy in this group and an introduction of a wide pool of novel regimens [10][11][12][13]. Currently, the most common regimens of adjuvant therapy are based on a combination of dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor) in patients with BRAF V600 mutation, as well as nivolumab or pembrolizumab (targeting programmed death receptor 1) in melanoma patients with or without BRAF V600 mutation [14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study

Ziętek

Teterycz

Wierzbicki

et al. 2023

Cancers

View full text Add to dashboard Cite

Background: In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. Methods: Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan–Meier methods and the Cox Proportional-Hazards Model were used for analysis. Results: The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88–41%), while the use of adjuvant treatment increased (11–51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69, p = 0.036)), but CLND did not (HR:1.22, p = 0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20, p = 0.002 for BRAF inhibitors and HR:0.50, p = 0.015 for anti-PD-1 inhibitors). Conclusions: Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.

show abstract

Real-World Adherence to Nodal Surveillance for Sentinel Lymph Node-Positive Melanoma

Cited by 12 publications

References 14 publications

Nodal ultrasound for regional recurrence detection in sentinel lymph node biopsy‐positive cutaneous melanoma patients undergoing cross‐sectional imaging

Nodal ultrasound for regional recurrence detection in sentinel lymph node biopsy‐positive cutaneous melanoma patients undergoing cross‐sectional imaging

Sentinel lymph node assessment in melanoma: current state and future directions

The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study

Contact Info

Product

Resources

About