Sentinel lymph node biopsy in extramammary Paget disease: A 13‐year institutional experience

Abstract

Whether sentinel lymph node biopsy status is a prognostic factor or effective in determining treatment strategies in extramammary Paget disease remains unclear. This study aimed to investigate the significance of sentinel lymph node biopsy in extramammary Paget disease. We retrospectively reviewed the clinical information of previously untreated patients with invasive extramammary Paget disease who underwent wide local excision of the primary tumor and sentinel lymph node biopsy at our hospital between April 2008 and March 2021. Clinical data including the baseline neutrophil-to-lymphocyte ratio and recurrence-free survival were analyzed. Sentinel lymph node metastases were

The Neutrophil-to-Lymphocyte Ratio as a Biomarker in Cutaneous Oncology: A Systematic Review of Evidence beyond Malignant Melanoma

“…Moreover, the NLR was an independent prognostic factor for overall survival ( p = 0.019) as well as an independent predictor of survival among EMPD patients with metastatic disease ( p = 0.036) [ 46 ]. In a follow-up multivariate analysis that included 85 patients with EMPD, the same authors found that NLR and a higher invasion level were the two independent predictive factors for SLN biopsy positivity [ 47 ]. Similarly, Ebata et al [ 48 ], in a retrospective study of 137 patients who underwent sentinel lymph node biopsy for EMPD, showed that an NLR > 3.0 was a predictor of lymph node metastasis (OR = 3.31, 95%CI: 1.117–9.804; p = 0.038).…”

Recent treatment and prognosis in 643 patients with extramammary Paget's disease

“…Although the Clinical Practice Guidelines for EMPD did not recommend SLNB 16 at present, several studies have shown the potential usefulness of SLNB for the early detection of metastasis in EMPD. [17][18][19] Fujisawa et al suggested that SLNB and subsequent LN dissection improved the survival of patients with early stage lymphatic spread. 20 However, in the present study, the prognosis of patients with stage II and IIIA disease did not significantly differ between patients with and without SLNB.…”

“…However, these results suggest that early detection of metastasis and complete surgical removal of tumour cells remain the gold standard in patients with EMPD. Although the Clinical Practice Guidelines for EMPD did not recommend SLNB 16 at present, several studies have shown the potential usefulness of SLNB for the early detection of metastasis in EMPD 17–19 . Fujisawa et al.…”

Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies

“…Although SLN status did not have an impact on survival, this might have been attributable to improved survival as a result of LND in SLNB-positive patients. Maeda et al also evaluated the outcomes of invasive EMPD patients who underwent SLNB [ 126 ]. In their study, sentinel lymph node metastases were classified as macrometastases and micrometastases, with a cutoff value for SLN of 2 mm, and this status of SLNB was an independent prognostic factor for RFS.…”

“…However, a population based on tumor characteristics in which the risk of positive SLNs is lower than the accepted cutoff value of 10% was not found in these studies. In contrast, the false-negative rate in EMPD has been reported to be low, at 6–8% [ 124 , 126 ]. Therefore, given that SLNB is a relatively safe procedure [ 121 , 122 ], simultaneous SLNB with primary tumor resection might be worth considering in EMPD cases with clinical findings suspicious for invasion including microinvasion, such as small ulceration and slightly elevated plaques.…”