Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma

Abstract

Background The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable. Methods We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database. Results Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93 months), the incidence of FN-SNB was 2.8 %. While calculated FN rate was 14.5 % [84 FN/(494 TP + 84 FN) × 100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5 % [46 FN/(494 TP + 46 FN) × 100 %]. On multivariate analysis, male gender (OR 2.0, 95 % CI 1.1–3.6, p = 0.018), head/neck primaries (OR 2.5, 95 % CI 1.3–4.8, p < 0.006), and LITR (OR 3.5, 95 % CI 2.1–5.8, p < 0.001) were associated with FN-SNB. Melanoma-specific survival (MSS) for the FN group was similar to the TP group at 5 years (68 vs. 73 %, p = 0.539). However, MSS declined more for the FN group with a longer follow up and was significantly worse at 10 years (44 vs. 64 %, p < 0.001). On multivariate analysis, FN-SNB was a significant predictor of worse MSS in melanomas <4 mm in Breslow thickness (HR 1.6; 95 % CI 1.1–2.5, p = 0.021). Conclusions Male gender, LITR, and head and neck tumors were associated with FN-SNB. FN-SNB was an independent predictor of worse MSS in melanomas <4 mm in thickness, but this survival difference did not become apparent until after 5 years of follow-up.

Predictors of false negative sentinel lymph node biopsy in trunk and extremity melanoma

“…A FN event leads to misleading prognostic information for patients and can delay adjuvant and regional therapy. Tumors located on the head and neck have been consistently identified as at higher risk for false negativity, thus supporting more routine use of SPECT‐CT in this population . However, risk factors for FN SLNB among patients with trunk and extremity tumors—in whom conventional 2‐dimensional lymphoscintigraphy is commonly performed—have not been well described.…”

“…A low NPV indicates a relatively high likelihood of nodal recurrence despite negative SLNB. Reported NPVs range from 94% to 97% with 94.3% in MSLT‐1 …”

A Metastização Cervical dos Cancros Cutâneos de Cabeça e Pescoço

“…31 Perante tal risco, está preconizada a avaliação de gânglio sentinela (GS) em melanomas com espessura de Breslow superior a 1 mm, seja nas orientações da AJCC, NCCN ou da Organização Mundial de Saúde (OMS). 5,32 A taxa de falsos negativos da biópsia de GS ronda os 8 a 20%. 30 Relativamente ao valor preditivo do gânglio sentinela, destaca-se o estudo publicado em 2016 por Lee et al, que descreve os resultados do acompanhamento de 2408 doentes ao longo de 22 anos.…”

“…Contudo, a taxa de falso negativos neste estudo aumenta para 24% nos casos de melanoma de cabeça e pescoço sendo, segundo os autores, o local de maior risco para falsos negativos, aumentado consequentemente o risco de recorrência e de metástases à distância. 32 Já anteriormente, em 2008, Guggeheim et al, em 392 doentes, detetaram esta tendência de maior número de falsos negativos do gânglio sentinela a nível da cabeça e pescoço, registando uma percentagem de 9,8%, em contraste com os 6,2% inguinais e 7,7% axilares. 33 Um das problemáticas da biópsia do GS a nível da cabeça e pescoço relaciona-se com a execução de pesquisa de gânglio sentinela a nível parotídeo.…”

SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes

“…This is particularly true for patients with head and neck melanomas, which are associated with higher rates of false negative biopsies. 2 Additionally, the drainage pattern of the head and neck is complex. Drainage patterns can be discordant from predicted patterns, 3,4 and a single lesion can drain to multiple basins.…”