Completion lymph node dissection after a positive sentinel node

Ploeg, Augustinus P. T. van der; Akkooi, Alexander C. J. van; Verhoef, Cornelis; Eggermont, Alexander M.M.

doi:10.1097/cco.0b013e32835dafb4

Cited by 25 publications

(10 citation statements)

References 102 publications

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“…Our study spanned 2000–2010 and 98.5% of our patients with a positive SLN underwent a CLND. Since this time the debate about whether CLND is indicated for all patients with positive SLN in melanoma has increased . It may be that patients with larger volume micrometastatic disease, which is more likely seen on FS, are the subset that benefit most from completion lymphadenectomy but this remains unproven.…”

Section: Discussionmentioning

confidence: 99%

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

et al. 2016

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FS analysis for SLNs spared approximately half of patients a second operation. Patients with a positive SLN detected on FS were more likely to have further nodal involvement. In our experience intraoperative pathologic analysis of melanoma SLNs does not impair our ability to detect SLN metastasis or lead to a high rate of false positive results or nodal recurrences. J. Surg. Oncol. 2016;114:879-883. © 2016 2016 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

et al. 2016

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“…To date several studies like MSLT-2 and the EORTC 1208 (Minitub) are being performed to investigate whether CLND can be spared in these patients [36,37].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Voit

Gooskens

Siegel

et al. 2014

European Journal of Cancer

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Background: Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanoma patients is controversial and subject of this study. Methods: Between 2001 and 2010 over 1000 stage I/II consecutive melanoma patients prospectively underwent US-FNAC prior to SN biopsy. All patients underwent lymphoscintigraphy prior to US-FNAC. The Berlin US morphology criteria: Peripheral perfusion (PP), loss of central echoes (LCE) and balloon shaped (BS) were registered. FNAC was performed in case of presence of any of these factors. SN tumour burden was measured according to the Rotterdam criteria. All patients underwent SN or lymph node dissection (LND) in case of positive FNAC. Findings: Mean/median Breslow thickness was 2.58/1.57 mm. Mean/median follow-up was 56/53 months (1-132). SN positivity rate was 21%. US-FNAC Sensitivity was 71% (US only) and 51% (US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). PP, LCE and BS had sensitivity of 69%, 24% and 24% respectively. Sensitivity of (2014) 50, 2280-2288 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m US-FNAC increased with increasing SN tumour burden. PP was an early sign of metastasis (58% in <0.1 mm metastases). Threshold size of a metastasis for FNAC was 0.3 mm. Five-year survival correlated to US-FNAC status (95% in negative and 59% in positive). Interpretation: Ultrasound guided FNAC (US-FNAC) according to the Berlin morphology criteria could correctly identify at least half of all tumour positive sentinel nodes, prior to the surgical SN procedure. Peripheral perfusion is an early sign of metastasis, which is very sensitive, but with lower positive predictive value (PPV). It is responsible for the sensitivity of the procedure. Balloon shape is a sign of advanced metastases, with lower sensitivity, but high PPV. US-FNAC sensitivity correlated with increasing T-stage, ulceration of the primary and increasing SN tumour burden. US-FNAC status accurately predicts survival.

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“…[6][7][8][9][10][11] It has been proposed that patients with very small SN metastases (\0.1 mm diameter) have a favorable outcome and may not need completion lymphadenectomy. [12][13][14] Others have not been able to confirm these claims 10,15 which are, in any case, weakened by the fact that follow-up in the reported studies was initially short and that, predictably, recurrences and deaths have accumulated in this 'favorable' group as follow-up periods have increased. Coupled with this dilemma are concerns about the extent of nodal sampling required to accurately determine that NSNs are truly metastasis-free.…”

mentioning

confidence: 90%

Identification, Clinical Significance, and Management of Very Small Melanoma Metastases in Sentinel Lymph Nodes

Cochran

2015

Ann Surg Oncol

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Completion lymph node dissection after a positive sentinel node

Cited by 25 publications

References 102 publications

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Identification, Clinical Significance, and Management of Very Small Melanoma Metastases in Sentinel Lymph Nodes

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