Reliability of sentinel lymph node biopsy for staging melanoma

Jansen, Liesbeth; Nieweg, Omgo E.; Peterse, J. L.; Hoefnagel, Cornelis A.; Olmos, Renato A. Valdés; Kroon, Bin B. R.

doi:10.1046/j.1365-2168.2000.01362.x

Cited by 167 publications

(87 citation statements)

References 17 publications

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“…The histological status of the SLN has been found to be an indicator representative of the whole LN basin. It has turned out to be the strongest prognostic factor for tumor recurrence and survival [2][3][4][5][6] , and a major decision criterion for adjuvant therapy [7,8] .…”

Section: Introductionmentioning

confidence: 99%

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Kraft

Havel

2012

JBGC

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Background: The most important prognostic factor in melanomas, breast cancers and gynecologic tumors is the state of the lymph nodes (LNs). There is not suitable pre-surgery examination procedure of detection of impacted LNs. The use of lymphatic mapping of sentinel lymph node (SLN) helps reduce the morbidity of surgery. Accurate visualization of the SLN is required for the best results. The aim is to assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in SLN detection in patients with various types of tumors and estimation of some factors influencing detection success -age, gender and body mass index (BMI). Methods:Planar scintigraphy and hybrid modality SPECT/CT were performed in 550 patients (pts) (mean age 58.1 ± 13.1 years): 69 pts with gynecological tumors (37 with cervical cancer, 25 pts with endometrial cancer, 7 pts with vulvar carcinoma); in 161 pts with melanomas; and in 318 women and 2 men with breast cancer. The radiopharmaceutical was injected around the tumor, subareolar or around the scar. Planar and SPECT/CT images were interpreted separately by two nuclear medicine physicians. Efficacy of these two techniques to image SLN were compared. We have estimated the influence of the age, gender and BMI on the succes rate of SLN detection. Student's paired t-test was used for comparing numbers of found SLN by both techniques; F-test, Student's t-test, and Fisher's exact test were utilized for age, gender and BMI characteristics comparisons. Values were considered significant when P<0.05. Results:Planar scintigraphy did not image SLN in 77 pts in total (14.0 %); in 8 pts with gynecologic tumors, in 23 pts with melanomas and in 46 pts with breast cancer. SPECT/CT was negative in 49 pts (8.9 %) in total; in 4 pts with gynecologic tumors, in 12 pts with melanomas and in 33 pts with breast cancer. In 199 (36.2 %) pts the number of SLNs captured on SPECT/CT was higher than on planar imaging. 35 foci of uptake (3.1 % from totally visible 1134 foci on planar images) interpreted on planar images as hot LNs were found to be false positive non-nodal sites of uptake when further assessed on SPECT/CT. Influence of the age, gender and BMI: The group of patients with higher number of detected SLN on SPECT/CT than on planar scintigraphy had lower average age than the group of patients with the same number of detected SLN on SPECT/CT and on planar scintigraphy, the difference was statistically significant (P=0.008). BMI did not differ in these two groups. There has been proportionally higher number of men than women who have had higher detected SLNs on SPECT/CT than on planar scintigrams (difference statistically significant P=0.04). It follows that gender influences the difference of detected SLNs on SPECT/CT and planar scintigraphy in favor of male gender. Conclusion:In some patients with gynecologic, including breast cancers and melanomas SPECT/CT improves detection of SLNs as compared to planar scintigraphy. It can image nodes not visible on planar scintigrams, excludes false positiv...

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Section: Introductionmentioning

confidence: 99%

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Kraft

Havel

2012

JBGC

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“…6 Breslow thickness (measured in millimeters) is the only reproducible factor predictive of SLN status in all studies. [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Several other factors have been variably and sometimes discordantly reported to have predictive value for SLN metastasis, including Clark level, ulceration, mitotic rate, microsatellitosis, angiolymphatic invasion, vertical growth phase, number of nodal basins, primary tumor location, and patient age. [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Several plausible explanations could account for the disparate and sometimes conflicting predictive models that have been offered to date.…”

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confidence: 99%

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

et al. 2004

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Background: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy.Methods: We reviewed 419 patients who underwent SLN biopsy for melanoma from a prospectively collected melanoma database. To derive a probabilistic model for the occurrence of a positive SLN, a multivariate logistic model was fit by using a stepwise variable selection method. The accuracy of each model was evaluated by using receiver operator characteristic curves.Results: On univariate analysis, the number of mitoses per square millimeter, increasing Breslow depth, decreasing age, ulceration, and melanoma on the trunk showed a significant relationship to a positive SLN. Multivariate analysis revealed that once age, mitotic rate, and Breslow thickness were included, no other factor, including ulceration, was significantly associated with a positive SLN. The data suggest that younger patients with tumors Ͻ1 mm may still have a substantial risk for a positive SLN, especially if the mitotic rate is high.Conclusions: In addition to Breslow depth, mitoses per square millimeter and younger age were factors identified as independent predictors of a positive SLN. This model may identify patients with thin melanoma at sufficient risk for metastases to justify SLN biopsy.

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“…With long-term follow-up of patients with negative sentinel nodes there is a small but definite incidence of recurrence in the mapped and sampled nodal basin. 5,[10][11][12][13][14][15][16][17][18][19] These patients may be considered to have a false-negative result of their sentinel node biopsy procedure. Previous reports have suggested that the majority of patients who recur in the relevant node field will, in fact, have identifiable metastases in the biopsied sentinel node if a more comprehensive histopathologic evaluation of the node is undertaken.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Furthermore, the presence or absence of metastases in the sentinel node is the most important prognostic factor for melanoma patients. 9 For a sentinel node to provide accurate prognostic information, it is essential that 'true' sentinel nodes are removed and examined thoroughly.…”

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confidence: 99%

“…With long-term follow-up of patients with negative sentinel nodes, some develop a recurrence in the mapped and sampled nodal basin and these patients may be considered to have a false-negative result of their sentinel node biopsy procedure. A technique to confirm true sentinel node identity may reduce the false-negative rate of the procedure, which has been disappointingly high (up to 44%) in several recently reported studies, 5,[10][11][12][13][14][15][16][17][18][19] or at least provide a retrospective explanation for a falsenegative result.…”

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confidence: 99%

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Antimony concentrations in nodal tissue can confirm sentinel node identity

Scolyer

Thompson

et al. 2004

Modern Pathology

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The sentinel node biopsy procedure is a highly accurate method of staging patients with cutaneous melanoma and the tumor-harboring status of sentinel nodes is the most important prognostic factor. For the procedure to provide accurate prognostic information, however, it is essential that 'true' sentinel nodes are removed and examined thoroughly. A technique to confirm sentinel node identity may reduce the false-negative rate of the procedure. We have found that antimony (originating from the antimony sulfide colloid used for preoperative lymphoscintigraphy in our institution) can be measured in tissue sections of sentinel nodes using inductively coupled plasma mass spectrometry. The aims of this study were to determine whether antimony concentrations can be used to confirm that removed sentinel nodes are 'true' sentinel nodes and to differentiate sentinel nodes from nonsentinel nodes. In all, 24 patients who had both a tumor-positive sentinel node and a tumor-negative nonsentinel node removed from one regional node field during the same operation, were identified. Tissue sections (50 lm) thick were cut from archival paraffin blocks of each of the sentinel nodes and nonsentinel nodes. Antimony concentrations in the tissue sections were measured using inductively coupled plasma mass spectrometry. The median and mean concentrations of antimony in parts per billion were 0.526 and 1.198, respectively (range 0.020-7.596) in the sentinel nodes, and 0.043 and 0.123 (range 0-0.800) in the nonsentinel nodes (P ¼ 0.004). In four of the 24 pairs, both the presumed sentinel nodes and the nonsentinel nodes had very low antimony levels (less than 0.18 parts per billion), suggesting that nodes designated as sentinel nodes may not have been 'true' sentinel nodes. It is concluded that determination of antimony concentrations within sentinel nodes using the highly sensitive method of inductively coupled plasma mass spectrometry can confirm the identity of sentinel nodes and validate the sentinel node technique.

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Reliability of sentinel lymph node biopsy for staging melanoma

Abstract: The sentinel node status was a strong prognostic factor, even with a false-negative rate of 11 per cent. Published in abstract form as Eur J Nucl Med 1999; 26(Suppl): S57

Cited by 167 publications

References 17 publications

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

Antimony concentrations in nodal tissue can confirm sentinel node identity

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