Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes

Kunte, Christian; Geimer, Till; Baumert, Jens; Konz, Birger; Volkenandt, Matthias; Flaig, Michael J.; Ruzicka, Thomas; Berking, Carola; Schmid‐Wendtner, Monika‐Hildegard

doi:10.1016/j.jaad.2010.02.047

Cited by 23 publications

(22 citation statements)

References 39 publications

(40 reference statements)

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“…In our study, the microanatomic features of the SLNs metastasis, particularly the tumour penetrative depth of the deposit (according with Starz classification) and several clinic-pathologic data were analyzed looking for a predictive marker for NSLN involvement. Among 80 cases underwent CLND, 15 patients (19%) had NSLN positivity, while the remaining 65 (81%) had no metastases, according to the data reviewed from the literature [13,14,18,27-30]. Patients presenting a positive CLND were all classified as S2 or S3 at the SLN histological micro-morphometric analysis confirming that Starz classification is an indicative factor of high risk of regional nodal recurrence.…”

Section: Discussionmentioning

confidence: 80%

“…Other ways, the positivity to a SLN biopsy lead the patient to a completion lymph node dissection (CLND) and approximately the 35%–50% of SLN positive patients die within 5 years [13-15]. Morton et al demonstrated a highly significant survival benefit in SLN-positive patients who had received CLND (5-year survival rate 72%) compared to SLN-positive patients who had received delayed ELND (Elective LND) after clinical detection of lymph node metastasis (5-year survival rate 52%) [16].…”

Section: Discussionmentioning

confidence: 99%

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SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

Migliano

Bellei

Govoni

et al. 2013

J Exp Clin Cancer Res

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BackgroundCompletion lymph node dissection (CLND) is the gold standard treatment for patients with a positive sentinel lymph node (SLN) biopsy. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis. The objective of this study is to identify patients with a very low risk to develop non-SLNs recurrences and to limit unnecessary CLND.MethodsA retrospective long-term study of 80 melanoma patients with positive SLN, undergone CLND, was assessed to define the risk of additional metastasis in the regional nodal basin, on the basis of intranodal distribution of metastatic cells, using the micro-morphometric analysis (Starz classification).ResultsThis study demonstrates that among the demographic and pathologic features of primary melanoma and of SLN only the Starz classification shows prognostic significance for non-SLN status (p<0.0001). This parameter was also significantly associated with disease-free survival rate (p<0.0013).ConclusionThe Starz classification can help to identify, among SLN positive patients, those who can have a real benefit from CLND. From the clinical point of view this easy and reliable method could lead to a significant reduction of unnecessary CLND in association with a substantial decrease in morbidity. The study results indicate that most of S1 subgroup patients might be safely spared from completion lymphatic node dissection. Furthermore, our experience demonstrated that Starz classification of SLN is a safe predictive index for patient stratification and treatment planning.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

Migliano

Bellei

Govoni

et al. 2013

J Exp Clin Cancer Res

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“…38 In patients with breast cancer who have submicrometastases, defined as ,0.2 mm in largest diameter in their SLNs, they are considered prognostically the same as patients with a negative SLN. [5][6][7][8][9]19,[41][42][43] van Akkooi et al 6 studied 74 patients with a positive SLN biopsy for MM and found that none of their 15 patients with SLN tumor burden ,0.1 mm in largest diameter had additional non-SLN involvement; however, this only approached statistical significance with a P value of 0.07. [5][6][7][8][9]19,[41][42][43] van Akkooi et al 6 studied 74 patients with a positive SLN biopsy for MM and found that none of their 15 patients with SLN tumor burden ,0.1 mm in largest diameter had additional non-SLN involvement; however, this only approached statistical significance with a P value of 0.07.…”

Section: Discussionmentioning

confidence: 99%

“…2) making it at times difficult to interpret, especially based on one cell. 6,7,9,[19][20][21][22][23]41,42 Reeves et al 7 reported that 16% of the patients (16 of 98) with a positive SLN biopsy had further non-SLNs positive for MM. Nevertheless, Yan et al 46 looked at 217 lymph nodes from patients with no history of melanoma and found a 5% falsepositive rate with Mart-1 and a 2.4% false-positive rate with Melan-A.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Evaluation of the Sentinel Lymph Node for Malignant Melanoma

Cole

Ferringer

2014

The American Journal of Dermatopathology

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Metastasis from malignant melanoma (MM) usually first presents in the draining lymph node basin and thus sentinel lymph node (SLN) biopsy is a staging tool used to predict risk of metastases and death in higher risk tumors and has become the standard of care. Differences in the processing and methods used in the histopathological examination of SLNs can affect the positivity rate for metastatic MM because isolated MM deposits may be small and variably distributed in the SLN. The examination of SLNs is not standardized. The authors surveyed institutions across the United States who process SLNs for MM to better characterize the current methods used and to suggest a standardized approach to improve the reliability of the SLN biopsy. A survey of 142 academic institutions in the United States regarding the methods used in the evaluation of the SLN biopsy for MM was conducted. Thirty-two institutions responded. Eighty-one percent of the institutions (26 of 32) had a protocol that they used for SLN examination. In regards to gross dissection, 28% of the responders (9 of 32) initially bivalve (cut the SLN in half), whereas 59% (19 of 32) use a bread loaf technique, cutting the SLN at even intervals without specifically commenting about orientation to the hilum. The number of levels initially cut from the SLN block varied from 1 to 8 levels per block. Thirty-nine percent of the respondents (12 of 31) routinely order immunohistochemistry before evaluation of the initial hematoxylin- and eosin-stained sections. Eighty percent of the respondents (24 of 30) report the maximum dimension of the metastatic tumor deposit. The response rate was low (22%), and most respondents did not indicate how many SLN accessions were performed at their institution each year. Histologic protocols for processing SLNs for MM vary among institutions. Different methods of handling SLNs result in varying sensitivities for detection of metastases. Data derived from these varied approaches to develop and determine prognostic and staging categories may be inconsistent. A standardized yet practical approach is needed to provide reliable information on which prognosis can be determined and therapeutic guidelines can be based. The hope is for dermatologists and those treating patients with MM to understand the intricacies and inconsistencies involved in performance and interpretation of this key staging tool.

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“…Previous studies [9,10,23-25] indicate that overall SLN tumor burden, primary tumor thickness, and number of SLN harvested may be useful in identifying a group at low risk for positive NSLN. It is nonetheless interesting that these two parameters are also predictive for SLN micrometastases [20,26].…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002–2009)

et al. 2012

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BackgroundSince the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.MethodsA single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.ResultsThe SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.ConclusionOur data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.

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Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes

Cited by 23 publications

References 39 publications

SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

Histopathologic Evaluation of the Sentinel Lymph Node for Malignant Melanoma

Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002–2009)

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