Comparison of Sentinel Lymph Node Micrometastatic Tumor Burden Measurements in Melanoma

Egger, Michael E.; Bower, Matthew; Czyszczon, Irene A.; Farghaly, Hanan; Noyes, R. Dirk; Reintgen, Douglas S.; Martin, Robert C.; Scoggins, Charles R.; Stromberg, Arnold J.; McMasters, Kelly M.

doi:10.1016/j.jamcollsurg.2013.12.014

Cited by 39 publications

(29 citation statements)

References 29 publications

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“…Although there are several arguments against performing a CLND in patients with minimal melanoma disease burden in the SLN, such as morbidity of lymphadenectomy and emerging targeted immunotherapies, there is value of a CLND with respect to staging and prognosis . Multiple studies have reported that the presence of metastatic non‐SLNs is an independent negative prognostic factor associated with significantly lower disease‐free survival, melanoma‐specific survival, and overall survival . Knowing the status of the non‐sentinel nodes is often important for entry into clinical trials .…”

Section: Discussionmentioning

confidence: 99%

National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma

Hewitt

Merkow

DeLancey

et al. 2018

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma

Hewitt

Merkow

DeLancey

et al. 2018

Journal of Surgical Oncology

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“…The Sunbelt Melanoma Trial and the University of Louisville Melanoma Databases were queried for patients with a single primary cutaneous melanoma and a single positive SLN who underwent CLND from 1997 to 2016. Only patients with complete data regarding the parameters described below were included in our analysis . Details of the Sunbelt Melanoma Trial have been described previously .…”

Section: Methodsmentioning

confidence: 99%

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

Bhutiani

Egger

Stromberg

et al. 2018

Journal of Surgical Oncology

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Background Identifying factors associated with nonsentinel lymph node (NSN) metastases in melanoma patients with a single positive sentinel lymph node (SLN) could aid decision making regarding adjuvant therapy. We describe a model for identifying patients with a single positive SLN at low risk for NSN metastasis. Methods Factors associated with NSN metastasis in patients with a primary cutaneous melanoma and a single positive SLN who underwent completion lymph node dissection (CLND) were identified. These factors were used to construct a model for predicting the NSN status. The model was validated using a separate data set from another tertiary referral cancer center. Results In the training data set, 111 patients had a single positive SLN. Of these, 27 had positive NSN. SLN tumor deposit diameter ≥0.75 mm (OR, 3.43; P = 0.047), age ≥40 (OR, 12.14; P = 0.024), and multifocal SLN tumor deposit location (OR, 4.16; P = 0.0096) were independently associated with NSN positivity. Patients with 0 to 1 of these risk factors had a low risk of NSN metastasis in both the training (7.5%) and validation (4.6%) data sets. Conclusions A combination of patient and SLN tumor burden characteristics can help to identify patients with a single positive SLN who are at a low risk of NSN metastasis.

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“…There is significant and growing evidence that microscopic tumor burden in the SLN is prognostically important. [78][79][80][81][82][83][84][85][86][87][88][89][90] SLN tumor burden can be assessed by a variety of micromorphometric parameters, including the maximum size of the largest metastasis, the maximum subcapsular depth (also known as tumor penetrative depth 88 of the deposits and measured from the inner surface of the lymph node capsule to the deepest intranodal tumor cell), the microanatomic location of SLN tumor deposits, the percentage crosssectional area of the SLN that is involved, and the presence of extranodal extension. In various studies, one or more of these parameters has predicted survival in SLN-positive patients.…”

Section: Sln Microscopic Tumor Burdenmentioning

confidence: 99%

“…In various studies, one or more of these parameters has predicted survival in SLN-positive patients. [78][79][80][81][82][83][84][85][86][87][88][89][90] The impact of extent of SLN tumor burden (based on the greatest maximum dimension of the largest discrete, metastatic melanoma deposit) was assessed for the subset of patients with known SLN tumor burden in the IMDDP. In univariate analysis, increasing SLN tumor burden was associated with reduced MSS (Fig.…”

Section: Sln Microscopic Tumor Burdenmentioning

confidence: 99%

Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Gershenwald

Scolyer

Hess

et al. 2017

CA A Cancer J Clinicians

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1,704

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To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8–1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA–IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials.

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Comparison of Sentinel Lymph Node Micrometastatic Tumor Burden Measurements in Melanoma

Cited by 39 publications

References 29 publications

National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma

National practice patterns of completion lymph node dissection for sentinel node‐positive melanoma

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

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