Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma

Straker, Richard J.; Carr, Michael J.; Sinnamon, Andrew J.; Shannon, Adrienne B.; Sun, James; Landa, Karenia; Baecher, Kirsten; Wood, Christian; Lynch, Kevin; Bartels, Harrison G.; Panchaud, Robyn; Lowe, Michael C.; Slingluff, Craig L.; Jameson, Mark J.; Tsai, Kenneth Y.; Faries, Mark B.; Beasley, Georgia M.; Sondak, Vernon K.; Karakousis, Giorgos C.; Zager, Jonathan S.; Miura, John T.

doi:10.1245/s10434-021-10031-z

Cited by 9 publications

(22 citation statements)

References 35 publications

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“…While Kachare et al first reported a 5.4% 5-year MCC-specific survival advantage in patients receiving SLNB compared with nodal observation in a SEER database analysis [70], prospective confirmation is lacking. A more recent multi-institutional retrospective report by Straker et al suggests failure to detect regional nodal microscopic disease with SLNB is associated with a survival detriment, with a 5-year OS of 69.9% for patients with true negative biopsies compared to 48.1% in false negative biopsies [71]. Despite the unknown effect of sentinel node evaluation on overall survival, SLNB should be considered for all clinically node-negative MCC patients whenever possible per NCCN and EORTC/EADO guidelines, as no specific tumor characteristics have consistently been identified that portend a lower risk of a negative nodal involvement.…”

Section: Sentinel Lymph Node Biopsymentioning

confidence: 99%

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Yusuf

McKenzie

Rattani

et al. 2021

Cancers

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Merkel cell carcinoma (MCC) is a rare, cutaneous neuroendocrine malignancy with increasing incidence. The skin of the head and neck is a common subsite for MCC with distinctions in management from other anatomic areas. Given the rapid pace of developments regarding MCC pathogenesis (Merkel cell polyoma virus (MCPyV)-positive or virus-negative, cell of origin), diagnosis, staging and treatment, and up to date recommendations are critical for optimizing outcomes. This review aims to summarize currently available literature for MCC of the head and neck. The authors reviewed current literature, including international guidelines regarding MCC pathogenesis, epidemiology, diagnosis, staging, and treatment. Subsequently recommendations were derived including the importance of baseline imaging, MCPyV serology testing, primary site surgery, nodal evaluation, radiotherapy, and the increasing role of immune modulating agents in MCC. MCPyV serology testing is increasingly important with potential distinctions in treatment response and surveillance between virus-positive and virus-negative MCC. Surgical management continues to balance optimizing local control with minimal morbidity. Similarly, radiotherapy continues to have importance in the adjuvant, definitive, and palliative setting for MCC of the head and neck. Immunotherapy has changed the paradigm for advanced MCC, with increasing work focusing on optimizing outcomes for non-responders and high-risk patients, including those with immunosuppression.

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Section: Sentinel Lymph Node Biopsymentioning

confidence: 99%

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Yusuf

McKenzie

Rattani

et al. 2021

Cancers

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“…While evidence for false negative SLNB is largely based on melanoma studies, little data exist describing predictors and outcomes of patients with MCC with false‐negative SLNB. The NCCN considers head and neck primary tumor location as risk factor alone, however history of primary tumor excision before SLNB and profound immunosuppression are also thought to be associated with false negativity 14,20 …”

Section: Resultsmentioning

confidence: 99%

“…68 A study conducted by Straker et al looked at the predictors of false negative SLNB in MCC and concluded males sex, age above 75 years, and LVI may be at increased risk for false negative SLNB, arguing increased nodal surveillance following negative SLNB in these high-risk patients may aid in early identification of regional nodal recurrences. 20 Furthermore, variations in the application of SLNB techniques have led to differences in successful SLN identification, which have been reflected in the reported regional relapse rates in patients with negative SLNB, ranging from 5% to 12% with corresponding falsenegative rates between 17% and 21%. [69][70][71] Nevertheless, SLNB has proven to detect occult metastasis in approximately one-third of patients who are clinically node-negative.…”

Section: Discussionmentioning

confidence: 99%

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Best practices in surgical and nonsurgical management of head and neck Merkel cell carcinoma: An update

Duarte-Bateman

Shen

Bullock

et al. 2022

Molecular Carcinogenesis

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Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous neuroendocrine carcinoma. Controversy exists regarding optimal management of MCC as high-quality randomized studies and clinical trials are limited, and physicians are bound to interpret highly heterogeneous, retrospective literature in their clinical practice. Furthermore, the rising incidence and notably poor prognosis of MCC urges the establishment of best practices for optimal management of the primary tumor and its metastases. Herein, we summarized the relevant evidence and provided an algorithm for decision-making in MCC management based on the latest 2021 National Comprehensive Cancer Network guidelines. Additionally, we report current active MCC clinical trials in the United States. The initial management of MCC is dependent upon the pathology of the primary tumor and presence of metastatic disease. Patients with no clinical evidence of regional lymph node involvement generally require sentinel node biopsy (SLNB) while clinically node-positive patients should undergo fine needle aspiration (FNA) or core biopsy and full imaging workup. If SLNB or FNA/core biopsy are positive, a multidisciplinary team should be assembled to discuss if additional node dissection or adjuvant therapy is necessary. Wide local excision is optimal for primary tumor management and SLNB remains the preferred staging and predictive tool in MCC. The management of MCC has progressively improved in the last decade, particularly due to the establishment of immunotherapy as a new treatment option in advanced MCC. Ongoing trials and prospective studies are needed to further establish the best practices for MCC management.

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“…Aufgrund dieses unspezifischen klinischen Erscheinungsbildes kann die Diagnose eines MCC nur selten sicher rein klinisch gestellt werden und muss daher mittels feingeweblichen Untersuchung unter Berücksichtigung immunhistochemischer Färbungen bestätigt werden. Nach Diagnosestellung sollte, nachdem eine fassbare lymphogene Metastasierung und darüber hinaus Fernmetastasierung ausgeschlossen worden ist (siehe Kapitel 2.3), aufgrund der hohen Zahl von okkulten Lymphknotenmetastasen, zur besseren Einschätzung der Prognose und der Notwendigkeit für weitere Maßnahmen die Durchführung einer Schildwächterlymphknoten‐Biopsie erfolgen 22,34,35 …”

Section: Diagnostikunclassified

S2k‐Leitlinie – Merkelzellkarzinom – Update 2022

Becker

Beer

DeTemple

et al. 2023

J Deutsche Derma Gesell

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ZusammenfassungDas Merkelzellkarzinom (MCC, ICD‐O M8247/3) ist ein seltener, maligner, primärer Hauttumor mit epithelialer und neuroendokriner Differenzierung. Die Tumorzellen teilen viele morphologische, immunhistochemische und ultrastrukturelle Eigenschaften mit den Merkel‐Zellen der Haut. Die Ursprungszelle (cell of origin) des MCC ist dennoch unklar. Das MCC imponiert klinisch als ein rötlich bis violett farbiger kugeliger Tumor mit glatter glänzender Oberfläche und weicher bis prall‐elastischer Konsistenz, der in der Regel ein schnelles Wachstum aufweist. Spontane, häufig auch komplette Regressionen des Tumors werden beobachtet. Diese wahrscheinlich immunologisch‐vermittelten Regressionen erklären die Fälle, bei denen zum Zeitpunkt der Erstdiagnose nur Lymphknoten‐ oder Fernmetastasen gefunden werden und warum der Tumor auch in weit fortgeschrittenen Stadien sehr gut auf immunmodulierende Therapien anspricht. Aufgrund seiner Aggressivität, der in der Regel gegebenen Indikation zur Schildwächterlymphknotenbiopsie, der zu evaluierenden Indikation adjuvanter Therapien, sowie der Komplexität der notwendigen Diagnostik sollte das Vorgehen bereits bei Erstdiagnose durch ein interdisziplinäres Tumorboard festgelegt werden.

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Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma

Cited by 9 publications

References 35 publications

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Best practices in surgical and nonsurgical management of head and neck Merkel cell carcinoma: An update

S2k‐Leitlinie – Merkelzellkarzinom – Update 2022

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