Treatment influencing down-staging in EORTC Melanoma Group sentinel node histological protocol compared with complete step-sectioning: A national multicentre study

Riber-Hansen, Rikke; Hastrup, Nina; Clemmensen, Ole; Behrendt, Nille; Klausen, Siri; Ramsing, Mette; Spaun, Eva; Hamilton-Dutoit, Stephen; Steiniche, Torben

doi:10.1016/j.ejca.2011.08.019

Cited by 21 publications

(20 citation statements)

References 21 publications

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“…if enrolled in one of two current EORTC trials (EORTC 18071 and MINITUB) that include patients in part based on MMD. The number of potentially altered treatment courses was lower than the 34% we have previously shown . However, the difference between the previous and this study is the distance between the five central sections, which was 50 μm in the first study and 250 μm in this study.…”

Section: Discussioncontrasting

confidence: 92%

“…The number of potentially altered treatment courses was lower than the 34% we have previously shown . However, the difference between the previous and this study is the distance between the five central sections, which was 50 μm in the first study and 250 μm in this study. The larger distance between steps in this study probably led to a higher metastasis detection rate because more peripheral parts were included in the analysis.…”

Section: Discussioncontrasting

confidence: 92%

“…Moreover, as stated earlier , we found equal prognostic strengths for TMV and for MMD. Nonetheless, the great advantage of using TMV in comparison with MMD is the lack of systematic bias and up‐staging when adding sections to the histological protocol .…”

Section: Discussionmentioning

confidence: 99%

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Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

Riber-Hansen

Hamilton-Dutoit

Steiniche

2014

APMIS

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To validate metastasis location, maximum metastasis diameter (MMD) measurement induced stage migration and the prognostic significance of total metastatic volume (TMV) in melanoma sentinel lymph nodes (SLNs). A new 227 patient SLN cohort examined by complete step sectioning (250 μm) was tested for TMV and MMD prognostic significance; metastasis location by three different three-level protocols (Central vs Peripheral vs Global); and potential treatment changing down-staging by two restricted five-level protocols [Reduced Central (250 μm) vs Reduced Even (500 μm) sections]. Both TMV and MMD independently predicted recurrence (TMV, hazard ratio (HR): 1.21; 95% confidence interval (CI) 1.07-1.37; p = 0.003; and MMD, HR: 1.46; 95% CI 1.08-1.98, p = 0.02) and melanoma-specific death (TMV, HR: 1.30; 95% CI 1.11-1.51; p = 0.001; and MMD, HR: 1.82; 95% CI 1.25-2.66, p = 0.002). The Central, Peripheral and Global protocols detected 72%, 76% and 83% of metastases found by complete step sectioning. Based on MMD, using the Reduced Central or Reduced Even protocols, potential treatment changing down-staging occurred in 20 (20%) or 13 (13%) of SLN-positive patients. This validation study establishes that: (i) metastases are globally located in melanoma SLNs; (ii) MMD but not TMV leads to uni-directional stage migration; and (iii) TMV analysis is of prognostic significance.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussioncontrasting

confidence: 92%

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Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

Riber-Hansen

Hamilton-Dutoit

Steiniche

2014

APMIS

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“…Sectioning more than 50 mm could miss submicrometastases, as sometimes submicrometastases are smaller than 50 mm [42]. When cutting more, more clinically irrelevant metastases will appear [49]. Patients with minimal sentinel node tumor burden will in some cases show to have more advanced disease than was previously shown.…”

Section: Key Pointsmentioning

confidence: 97%

Completion lymph node dissection after a positive sentinel node

Ploeg¹,

Akkooi²,

Verhoef³

et al. 2013

Current Opinion in Oncology

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Consensus on the sentinel node pathology work-up and analysis protocols are crucial for correct risk stratification and for clinical decision-making. Primary and sentinel node tumor burden parameters and patient comorbidities should be taken into consideration when offering CLND to an individual patient. In the future, prospective studies such as the MSLT-II and the EORTC 1208 (Minitub) will provide answers to whether CLND has a therapeutic benefit and to which patients might safely be spared CLND.

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“…The examination followed the European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group (MG) protocol [8]. The SLN was bisected, followed by sectioning the central part of the lymph node in five levels, 50 mm apart.…”

Section: Pathologymentioning

confidence: 99%

Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure: clinical and economic outcome

Rødgaard

Kramer

Stolle

2013

Journal of Plastic Surgery and Hand Surgery

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The aim of this study was to compare a delayed sentinel node biopsy (dSNB) procedure with a same-day procedure (sSNB) in malignant melanoma. In March 2012, Aarhus University Hospital went from the dSNB to the sSNB procedure defined by lymphoscintigraphy (LS) and sentinel node biopsy (SNB) performed on the same day. Before that time, LS was performed 24 hours prior to SNB. The aim was to investigate whether differences between the two procedures exist. Patients who underwent the SNB procedure between April and July 2011 and 2012, respectively, were included in the study. The criteria for SNB were malignant melanoma thickness >1 mm, Clark level IV/V, and ulcus or unknown thickness of the melanoma. All patients underwent re-excision and SNB at the same time. Pathological evaluation was not changed in the observation periods; however, the LS procedures varied. Only a minor turnover among the surgeons was observed. One hundred and eight patients were included in the study, 59 (dSNB) from 2011 and 49 (sSNB) from 2012, respectively. A median of 2.17 (dSNB) and 2.31 (sSNB) SLNs were removed, with no statistical differences. No difference in node positivity rates was observed. However, the number of hospitalisation days differed significantly, with 1.94 days in dSNB and 0.49 days in sSNB. Rates of complications at the site of the SNB procedure were similar. No differences in disease-free survival (DFS) or overall survival (OS) were recorded. SNB does not increase the overall survival. It is, therefore, essential to keep the morbidity and economic costs low, while keeping the quality of the procedure high.

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Treatment influencing down-staging in EORTC Melanoma Group sentinel node histological protocol compared with complete step-sectioning: A national multicentre study

Cited by 21 publications

References 21 publications

Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

Completion lymph node dissection after a positive sentinel node

Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure: clinical and economic outcome

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