High positive sentinel node identification rate by EORTC melanoma group protocol

Akkooi, Alexander C. J. van; Wilt, Johannes H. W. de; Verhoef, Cornelis; Graveland, Wilfried J.; Geel, A.N. van; Kliffen, Mike; Eggermont, Alexander

doi:10.1016/j.ejca.2005.10.023

Cited by 91 publications

(11 citation statements)

References 34 publications

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“…[18] Van Akkooi et al reported a lesion as small as 0.5 mm in maximum diameter in a lymph node as small as 6 × 6 mm could be detected by an ultrasound. [6] Voit et al, however, reported that ultrasound-guided FNA could detect sentinel node tumors >1 mm in 76%, 0.1 to 1 mm in 46% and <0.1 mm in 23% of cases. [17] The significance of micrometastases <0.1 mm has been questioned,[42, 43] as whether patients with a positive SLNB need a completion lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…[3–5] However, it is still invasive, associated with definite morbidity, and usually performed under general anesthesia. Furthermore, only 15 to 30% of clinically node-negative melanoma patients will have a positive SLNB,[2, 6] and a delay before undergoing therapeutic lymphadenectomy is usually experienced by those patients while waiting for the final pathology result. Thus, detecting nodal involvement using a preoperative ultrasound appears to be an attractive option to eliminate the need for SLNB and its potential complications, costs of lymphoscintigraphy, and minimize the delay to therapeutic lymphadenectomy for node-positive patients.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

et al. 2011

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Background Sentinel lymph node biopsy (SLNB) is widely used in melanoma. Identifying nodal involvement preoperatively using high-resolution ultrasound may offer less invasive staging. This study assessed feasibility and staging results of clinically-targeted ultrasound (before lymphoscintigraphy) compared to SLNB. Methods From 2005–2009, 325 patients with melanoma underwent ultrasound before SLNB. We reviewed demographics and histopathologic characteristics, then compared ultrasound and SLNB results. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were determined. Results 325 patients, 58% male; 42% female, median age 58 years (range 18–86) were included. A total of 471 basins were examined with ultrasound. Only 6 patients (1.8%) avoided SLNB by undergoing ultrasound-guided fine needle aspiration of involved nodes, then therapeutic lymphadenectomy. 65 patients (20.4%) had 69 SLNB positive nodal basins; 17 nodal basins from 15 patients with positive ultrasounds were considered true-positive. 45 SLNB positive basins had negative ultrasounds (false-negative). 7 node-positive basins did not undergo ultrasound because of unpredicted drainage. 253 patients with negative SLNBs had negative ultrasounds in 240 nodal basins (true-negative) but false-positive ultrasounds occurred in 40 basins. Overall, sensitivity of ultrasound was 33.8%, specificity 85.7%, PPV 36.5% and NPV 84.2%. Sensitivity and specificity improved somewhat with increasing Breslow depth. Sensitivity was highest for the neck, but specificity was highest for the groin. Conclusions Routine preoperative ultrasound in clinically node-negative melanoma is impractical due to low sensitivity. Selected patients with thick or ulcerated lesions may benefit. Because of variable lymphatic drainage patterns, preoperative ultrasound without lymphoscintigraphic localization will provide incomplete evaluation in many cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

et al. 2011

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“…In addition, the results of these studies are variable: the proportion of SLN metastases ranges from <5% for studies on thin melanomas [19,20,27] to nearly 50% for studies on melanomas ≥4 mm in thickness [28]. It ranges between 12 and 31% for studies without restriction in thickness [29,30]. Numerous ‘mathematical' [17] or ‘computer-assisted' models [31], nomograms [32], prediction trees [20,27] and new classifications [33] have tried to improve the sensitivity of the criteria that are actually used to advocate the procedure in patients.…”

Section: Introductionmentioning

confidence: 99%

Breslow Thickness, Clark Index and Ulceration Are Associated with Sentinel Lymph Node Metastasis in Melanoma Patients: A Cohort Analysis of 612 Patients

Munsch

Lauwers‐Cancès

Lamant³

et al. 2014

Dermatology

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Background: Sentinel lymph node biopsy (SLNB) is the most sensitive procedure for assessing nodal status in patients with primary melanoma. Objective: To evaluate the predictive ability of usual primary melanoma prognosis factors of detecting sentinel lymph node (SLN) metastasis in patients with melanoma. Patients and Methods: A cohort of 612 consecutive patients presenting with primary skin melanoma who underwent a SLNB was evaluated. Assessment of the determinants of SLN metastasis was based on general linear model analysis. The model performance was studied using the concordance statistic and the net reclassification index. The calibration was estimated using the Hosmer-Lemeshow test. Results: The discrimination ability did not differ significantly between Breslow thickness (0.57), Clark index (0.61), ulceration (0.57) and histological subtype (0.55). Clark index, ulceration and Breslow thickness were all significant and independent determinants of SLN metastasis. The predictive ability of the final model was 0.657. Conclusion: Breslow thickness, Clark index and ulceration are independent predictors of a SLN metastasis.

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“…The presence of nodal metastases in patients with primary cutaneous melanoma is the most important factor that adversely affects the biological behavior and is related to poor prognosis 1–4,20,21. Sentinel node biopsy is perhaps the greatest contribution in surgical oncology of last 2 decades for assessment of the stage of regional nodes 22.…”

Section: Discussionmentioning

confidence: 99%

Multimarker Reverse Transcriptase-Polymerase Chain Reaction Assay in Lymphatic Drainage and Sentinel Node Tumor Burden

et al. 2010

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PurposeWe assessed molecular (presence of melanoma cells markers in lymph fluid [LY]) and pathological features (sentinel lymph node [SN] tumor burden according to Rotterdam criteria, metastases microanatomic location) and correlated them with survival and melanoma prognostic factors in a group of patients with positive SN biopsy.MethodsWe analyzed 368 consecutive SN-positive patients after completion lymph node dissection (CLND). In 321 patients we obtained data on SLN microanatomic location/tumor burden (only 7 cases had metastases <0.1 mm); in 137 we additionally analyzed 24-hour collected LY after CLND (multimarker reverse transcriptase-polymerase chain reaction [MM-RT-PCR] with primers for tyrosinase, MART1 (MelanA), and uMAGE mRNA (27.7% positive samples)]. Median follow-up time was 41 months.ResultsAccording to univariate analysis, the following factors had a negative impact on overall survival (OS): higher Breslow thickness (P = .0001), ulceration (P < .0001), higher Clark level (P = .008), male gender (P = .0001), metastatic lymph nodes >1 (P < .0001), nodal metastases extracapsular extension (P < .0001), metastases to additional non-SNs (P = .0004), micrometastases size ≥0.1 mm (P = .0006), and positive LY MM-RT-PCR (P = .0007). SN tumor burden showed linear correlation with increasing Breslow thickness (P = .01). The 5-year OS rates for SLN tumor burden <0.1 mm, 1–1.0 mm, and >1.0 mm were 84%/66%/44%, respectively, and for positive and negative LY MM-RT-PCR 47%/0%, respectively. The independent factors for shorter OS (multivariate analysis): male gender, primary tumor ulceration, number of involved nodes ≥4, micrometastases size >1.0 mm, and, in additional model including molecular analysis—positive MM-RT-PCR results (hazard ratio [HR] 3.2), micrometastases size >1.0 mm (HR 1.13), and primary tumor ulceration (HR 2.17). Similar results were demonstrated for disease-free survival (DFS) data.ConclusionsSN tumor burden categories according to Rotterdam criteria and the positive result of LY MM-RT-PCR assay demonstrated additional, independent prognostic value in SN-positive melanoma patients, showing significant correlation with shorter DFS and OS.

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High positive sentinel node identification rate by EORTC melanoma group protocol

Cited by 91 publications

References 34 publications

Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

Breslow Thickness, Clark Index and Ulceration Are Associated with Sentinel Lymph Node Metastasis in Melanoma Patients: A Cohort Analysis of 612 Patients

Multimarker Reverse Transcriptase-Polymerase Chain Reaction Assay in Lymphatic Drainage and Sentinel Node Tumor Burden

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