Validation of the Accuracy of Intraoperative Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma

Morton, Donald L.; Thompson, John F.; Essner, Richard; Elashoff, Robert M.; Stern, Stacey L.; Nieweg, Omgo E.; Roses, Daniel F.; Karakousis, Constantine P.; Mozzillo, Nicola; Reintgen, Douglas S.; Wang, He Jing; Glass, Edwin C.; Cochran, Alistair J.

doi:10.1097/00000658-199910000-00001

Cited by 727 publications

(462 citation statements)

References 52 publications

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“…One additional patient presented with metastases in the groin after being mapped in the ipsilateral axillary region. This yields a false-negative sentinel rate of 9.2% and a failure rate of 2.2%, which is in accordance with previous studies (Gershenwald et al, 1999;Morton et al, 1999;Morton et al, 2003;Vuylsteke et al, 2003). As previously shown by Gershenwald, detection failure of positive SLNs most commonly occurs because conventional histologic evaluation is unable to identify occult metastatic disease (Gershenwald et al, 1998).…”

Section: Discussionsupporting

confidence: 89%

Sentinel node status in melanoma patients is not predicitive for overall survival upon multivariate analysis

et al. 2005

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Sentinel lymph node biopsy (SLNB) has become a widely accepted standard procedure in the staging of patients with cutaneous melanoma and absence of clinical lymph node metastases, although there is no final proof that SLNB influences overall survival in these patients. This study investigated the accuracy of SLNB and the clinical outcome of patients after a mean follow-up of 22 months. Between 1998 and 2003, SLNB was performed in 309 consecutive patients. Patients with one or more positive sentinel lymph nodes (SLNs) were subjected to selective lymphadenectomy (SL). Survival analyses were performed using the Kaplan -Meier approach. A Cox proportional-hazard analysis was used for univariate and multivariate analysis to explore the effect of variables on survival. Sentinel lymph nodes were identified in 299 of 309 patients (success rate: 96.8%). Of these, 69 (23%) had a positive SLN. The falsenegative rate was 9.2%. Recurrence of disease to the regional lymph node basin (3.0%) and to the locoregional skin (2.6%) was rare in SLN-negative patients in contrast to SLN-positive patients (7.2 and 17.4%, respectively). The 3-year overall survival was 93 and 83% for SLN-negative and SLN-positive patients, respectively. Upon multivariate analysis, SLN status (Po0.001), Breslow thickness (Po0.02) and ulceration (Po0.026) were all found to be independent prognostic factors with respect to disease-free survival, whereas Breslow thickness proved to be the only significant factor with respect to overall survival.

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Section: Discussionsupporting

confidence: 89%

Sentinel node status in melanoma patients is not predicitive for overall survival upon multivariate analysis

et al. 2005

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“…3,8,[20][21][22][23][24][25] Technical failures may occur as a result of errors in lymphatic mapping and sentinel lymphadenectomy or because of a deficiency in the process of histopathologic evaluation. With long-term follow-up of patients with negative sentinel nodes there is a small but definite incidence of recurrence in the mapped and sampled nodal basin.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Furthermore, the presence or absence of metastases in the sentinel node is the most important prognostic factor for melanoma patients. 9 For a sentinel node to provide accurate prognostic information, it is essential that 'true' sentinel nodes are removed and examined thoroughly.…”

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confidence: 99%

“…3,[20][21][22][23][24][25] The procedure of sentinel node biopsy at the Sydney Melanoma Unit involves preoperative injection of a technetium-99m-labelled antimony trisulfide colloid for lymphoscintigraphy, and intraoperative injection of Patent Blue V dye (Guerbert, Aulney-Sous-Bois, France) at the primary melanoma site for visual identification of sentinel nodes. Because the blue dye does not survive the processing procedures necessary for histopathologic examination and because all the technetium99m has decayed by the time that sample is ready for analysis, these features cannot be used retrospectively to confirm that a 'true' sentinel node has been removed.…”

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confidence: 99%

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Antimony concentrations in nodal tissue can confirm sentinel node identity

Scolyer

Thompson

et al. 2004

Modern Pathology

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The sentinel node biopsy procedure is a highly accurate method of staging patients with cutaneous melanoma and the tumor-harboring status of sentinel nodes is the most important prognostic factor. For the procedure to provide accurate prognostic information, however, it is essential that 'true' sentinel nodes are removed and examined thoroughly. A technique to confirm sentinel node identity may reduce the false-negative rate of the procedure. We have found that antimony (originating from the antimony sulfide colloid used for preoperative lymphoscintigraphy in our institution) can be measured in tissue sections of sentinel nodes using inductively coupled plasma mass spectrometry. The aims of this study were to determine whether antimony concentrations can be used to confirm that removed sentinel nodes are 'true' sentinel nodes and to differentiate sentinel nodes from nonsentinel nodes. In all, 24 patients who had both a tumor-positive sentinel node and a tumor-negative nonsentinel node removed from one regional node field during the same operation, were identified. Tissue sections (50 lm) thick were cut from archival paraffin blocks of each of the sentinel nodes and nonsentinel nodes. Antimony concentrations in the tissue sections were measured using inductively coupled plasma mass spectrometry. The median and mean concentrations of antimony in parts per billion were 0.526 and 1.198, respectively (range 0.020-7.596) in the sentinel nodes, and 0.043 and 0.123 (range 0-0.800) in the nonsentinel nodes (P ¼ 0.004). In four of the 24 pairs, both the presumed sentinel nodes and the nonsentinel nodes had very low antimony levels (less than 0.18 parts per billion), suggesting that nodes designated as sentinel nodes may not have been 'true' sentinel nodes. It is concluded that determination of antimony concentrations within sentinel nodes using the highly sensitive method of inductively coupled plasma mass spectrometry can confirm the identity of sentinel nodes and validate the sentinel node technique.

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“…Several studies have shown that using a combination of the two methods improves results. 11,12 The idea is that either technique will identify the first echelon lymph node(s) draining the tumor site. 13 Many centers also use preoperative mapping with the addition of single photon emission CT (SPECT) to determine the location of the lymph node prior to surgery.…”

Section: Introductionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Head and Neck Melanoma: A Review

Corsten¹,

Johnson‐Obaseki²

2014

Journal of Patient-Centered Research and Reviews

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Follow this and additional works at: https://aurora.org/jpcrr Part of the Oncology CommonsJournal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. The incidence of melanoma in the United States continues to rise. Head and neck melanomas comprise approximately 20% of all primary cutaneous melanomas. Sentinel lymph node (SLN) biopsy (SLNB) has become the standard of care for staging in melanoma. It has a number of advantages, including the addition of prognostic information, accurate staging, and the potential to add completion lymph node dissection (CLND) or adjuvant therapy when indicated.

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Validation of the Accuracy of Intraoperative Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma

Cited by 727 publications

References 52 publications

Sentinel node status in melanoma patients is not predicitive for overall survival upon multivariate analysis

Sentinel node status in melanoma patients is not predicitive for overall survival upon multivariate analysis

Antimony concentrations in nodal tissue can confirm sentinel node identity

Sentinel Lymph Node Biopsy in Head and Neck Melanoma: A Review

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