Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas

Han, Dale; Han, Gang; Duque, Monica T.; Morrison, S.; Leong, Stanley P. L.; Kashani‐Sabet, Mohammed; Vetto, John T.; White, Richard L.; Schneebaum, Schlomo; Pockaj, Barbara A.; Mozzillo, Nicola; Sondak, Vernon K.; Zager, Jonathan S.

doi:10.1245/s10434-020-08706-0

Cited by 15 publications

(16 citation statements)

References 37 publications

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“…Furthermore, there is no consensus about which CP variables are prognostic for SLN positivity outside of staging factors, eg tumor thickness and ulceration status. 36 - 38 Many patients with T4 melanomas may be eligible for adjuvant therapy regardless of SLN status, and it is unclear if these patients should undergo the procedure. 36 …”

Section: Discussionmentioning

confidence: 99%

“… 36 - 38 Many patients with T4 melanomas may be eligible for adjuvant therapy regardless of SLN status, and it is unclear if these patients should undergo the procedure. 36 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is no consensus about which CP variables are prognostic for SLN positivity outside of staging factors, eg tumor thickness and ulceration status. [36][37][38] Many patients with T4 melanomas may be eligible for adjuvant therapy regardless of SLN status, and it is unclear if these patients should undergo the procedure. 36 A test to increase the accuracy of predicting a positive SLNB that complements NCCN guidelines could help patients and physicians when considering an SLNB.…”

Section: Discussionmentioning

confidence: 99%

“…[36][37][38] Many patients with T4 melanomas may be eligible for adjuvant therapy regardless of SLN status, and it is unclear if these patients should undergo the procedure. 36 A test to increase the accuracy of predicting a positive SLNB that complements NCCN guidelines could help patients and physicians when considering an SLNB. 37 Our data show that integrating CP features with the continuous 31-GEP score, which provides insight into intrinsic tumor biology, accurately predicts the likelihood of having a positive SLN.…”

Section: Discussionmentioning

confidence: 99%

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Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction

Whitman

Koshenkov

Gastman

et al. 2021

JCO Precision Oncology

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PURPOSE National guidelines recommend sentinel lymph node biopsy (SLNB) be offered to patients with > 10% likelihood of sentinel lymph node (SLN) positivity. On the other hand, guidelines do not recommend SLNB for patients with T1a tumors without high-risk features who have < 5% likelihood of a positive SLN. However, the decision to perform SLNB is less certain for patients with higher-risk T1 melanomas in which a positive node is expected 5%-10% of the time. We hypothesized that integrating clinicopathologic features with the 31-gene expression profile (31-GEP) score using advanced artificial intelligence techniques would provide more precise SLN risk prediction. METHODS An integrated 31-GEP (i31-GEP) neural network algorithm incorporating clinicopathologic features with the continuous 31-GEP score was developed using a previously reported patient cohort (n = 1,398) and validated using an independent cohort (n = 1,674). RESULTS Compared with other covariates in the i31-GEP, the continuous 31-GEP score had the largest likelihood ratio (G2 = 91.3, P < .001) for predicting SLN positivity. The i31-GEP demonstrated high concordance between predicted and observed SLN positivity rates (linear regression slope = 0.999). The i31-GEP increased the percentage of patients with T1-T4 tumors predicted to have < 5% SLN-positive likelihood from 8.5% to 27.7% with a negative predictive value of 98%. Importantly, for patients with T1 tumors originally classified with a likelihood of SLN positivity of 5%-10%, the i31-GEP reclassified 63% of cases as having < 5% or > 10% likelihood of positive SLN, for a more precise, personalized, and clinically actionable SLN-positive likelihood estimate. CONCLUSION These data suggest the i31-GEP could reduce the number of SLNBs performed by identifying patients with likelihood under the 5% threshold for performance of SLNB and improve the yield of positive SLNBs by identifying patients more likely to have a positive SLNB.

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Section: Discussionmentioning

confidence: 99%

“… 36 - 38 Many patients with T4 melanomas may be eligible for adjuvant therapy regardless of SLN status, and it is unclear if these patients should undergo the procedure. 36 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction

Whitman

Koshenkov

Gastman

et al. 2021

JCO Precision Oncology

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“…Оценка состояния зон регионарного лимфотока при обследовании онкологических больных имеет решающее значение в определении лечебной тактики и прогнозе течения заболевания [20][21][22]. Знание путей лимфотока позволяет вести целенаправленный поиск метастатически измененных лимфатических узлов.…”

Section: ядерная медицинаunclassified

Predictive Factors for Metastasis of Skin Melanoma of Varying Thickness According to Breslow to Sentinel Lymph Nodes

Николаева

Крылов²,

Рыжков

et al. 2021

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Purpose: To evaluate the prognostic factors in patients with Breslow skin melanoma of various thicknesses that affect the incidence of metastases in the signal lymph nodes (SLN).Material and methods: From November 2018 to November 2020, 324 patients with diagnosed melanoma of the skin of various localization and stages were examined and operated on. We used lymphotropic colloidal radiopharmaceutical (RPh) labeled with 99mTc. RPh with an activity of 150 MBq was administered one day before the operation intradermally around the scar of resected melanoma or peritumorally at 4 points in the case of a primary tumor. Lymphoscintigraphy was performed 1–3 hours after the RP injection on a Symbia E or Symbia E gamma camera (Siemens, Germany). Anteroposterior and lateral static polypositional scintigraphy was performed to determine the topography and mark the SLN. 324 planar studies were performed. In 259 cases, an additional study was performed SPECT (including SPECT / CT) on a Symbia T2 device (Siemens, Germany). Surgical intervention was performed the next day, taking into account the data of intraoperative radiometry using a domestic specialized hand-held gamma detector Radical (Amplituda, Russia).Results: The mean primary melanoma Breslow thickness was 2.77 ± 2.2 mm (range 0.2–13.0 mm). Localization of SLN: axillary (n = 161. 51 %), inguinal (n = 100. 31 %), cervical (n = 16. 5 %), submandibular (n = 9. 3 %), supraclavicular (n = 4. 1 %), more than one basin (n = 34. 9 %). In the group of melanomas <0.75 mm thick, no SLN metastases were found, among 0.75–1 mm melanomas, one positive lymph node with metastasis (SLN+) was found, in the largest group of melanomas of medium thickness (1–3.5 mm) — 25 (17 %). The largest percentage of metastases in SLN is determined in thick melanomas (>3.5 mm) — 17 (28 %), which is consistent with the data of foreign literature, while SLN is most often affected with a Breslow tumor thickness of more than 7 mm.In the group with negative sentinel lymph nodes (SLN–), the average tumor thickness according to Breslow was 2.6 ± 2.0 mm, in the SLN+ group — 4.0 ± 2.9 mm, the differences between the groups are statistically significant, which is confirmed by the result of one-way analysis of variance.The optimal threshold value of tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). An older age of patients (over 35 years old) is also associated with an increased incidence of metastases in the SLN, but this indicator is not statistically significant. Most often, SLN metastases were detected when the primary tumor was localized in the back (more often in men) and lower extremities (more often in women), while they are thicker (> 3.5 mm).Conclusion: 1. According to the ROC-analysis, the optimal threshold value of the tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). 2. Statistically significant prognostic factors of metastasis in SLN: localization of the primary tumor in the back (more often in men) and lower extremities (more often in women); Breslow thickness over 3.5 mm. 3. The absence of the influence of gender and age was noted, with a slight predominance of women in both groups.

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Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

Morrison

Han

Elenwa

et al. 2022

Cancer

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Background The significance of tumor‐infiltrating lymphocytes (TILs) in melanoma is debated. This article presents a multicenter, retrospective study assessing the predictive and prognostic value of TILs. Methods The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with known TIL data. TILs were categorized as absent or present, which included nonbrisk (NB), brisk (B), and present but unspecified TIL levels. Clinicopathologic factors were correlated with TILs, sentinel lymph node (SLN) status, and melanoma‐specific survival (MSS). Results Overall, 3203 patients were included. The median thickness was 1.5 mm, and 469 cases had SLN metastases. TILs were present in 2458 cases (76.7%), with NB, B, and unspecified TILs seen in 1691 (68.8%), 691 (28.1%), and 76 (3.1%), respectively. Multivariable analysis showed that the presence of TILs significantly predicted a negative SLN biopsy (P < .05). The median follow‐up was 25.2 months. MSS was significantly better for cases with TILs than cases without TILs (P < .001). According to multivariable analysis, age, gender, thickness, mitotic rate, ulceration, lymphovascular invasion, and SLN status were significantly prognostic of MSS (all P values < .05). Although TILs were not prognostic of MSS, when multiple imputation was used and the SLN status was excluded, the presence of TILs was significantly prognostic of improved MSS (hazard ratio, 0.78; 95% confidence interval, 0.64‐0.95; P = .0154). Conclusions TILs are a favorable marker because their presence significantly predicts a negative SLN, and the absence of TILs may be a prognostic marker of worse survival in patients with a positive SLN but not a negative SLN. TILs may also serve as a prognostic marker of survival when the SLN status is not considered.

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Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas

Cited by 15 publications

References 37 publications

Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction

Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction

Predictive Factors for Metastasis of Skin Melanoma of Varying Thickness According to Breslow to Sentinel Lymph Nodes

Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

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