S-classification of sentinel lymph node biopsy predicts the results of complete regional lymph node dissection

Abstract

The purpose of this study was to identify melanoma patients with positive sentinel lymph nodes (SLNs) at increased risk for further metastases in this specific lymph node basin. A series of consecutive patients with primary malignant melanoma stage I and II were evaluated retrospectively. The results of SLN biopsy in 26 patients with positive SLNs were compared with those of complete regional lymph node dissection (RLND) using the recently published S-classification of SLNs. The results of S-classification of SLNs were correlated with the outcome of complete RLND. There was a significant correlation between the S stage of positive SLNs and the results of complete RLND (P=0.02). Only patients with SIII stage (n=4) SLNs were found to have further metastases in the residual lymph node basin. The present study indicates that patients with SI stage and SII stage SLNs rarely have further metastases in the specific lymph node basin.

Prediction of Nonsentinel Lymph Node Metastasis in Malignant Melanoma

“…The fact that factors predictive of SLN positivity do not similarly predict non-SLN positivity may reflect a qualitatively different biological behavior of the two different types of metastases. Starz et al found that the depth of tumor penetration (calculated as distance in millimeters from the lymph node capsule) within the SLN predicted non-SLN positivity [17,18]. This was confirmed by Scolyer et al from Sydney through their study of 140 CLNDs for malignant melanoma [19].…”

Interobserver reproducibility of histologic parameters of melanoma deposits in sentinel lymph nodes

“…Parameters that were predictive in univariate analyses (and less so in multivariate analyses) include the location of tumor within SLNs,15, 20, 29 the TPD (centripetal thickness or maximum subcapsular depth),15, 24, 26, 30, 38-41 the presence of ECS,22 the presence of tumor in perinodal lymphatics,40 and SLN tumor burden or size 15, 20, 21, 25-28, 39, 40. Many of these parameters also predict clinical outcome and provide important prognostic information.…”

“…TPD is defined as the maximum subcapsular depth of tumor within the SLN) 15, 24, 26, 30, 38-40. ECS is the presence of tumor in perinodal tissues external to the lymph node capsule associated with the presence of tumor within the SLN 22.…”

Value of micromorphometric criteria of sentinel lymph node metastases in predicting further nonsentinel lymph node metastases in patients with melanoma

“…Other reports have also confirmed that the microanatomic location of SN metastases by Dewar et al [16] and the S-classification by Starz et al [17,24] are helpful tools for using the SN tumor burden to predict further non-SN metastases [19,23,26,39]. The investigators were also able to predict the non-SN status by the classification of the SN tumor burden on the basis of the maximum diameter of SN metastases using the cutoff levels proposed by Van Akkooi et al [32,35,36], also known as the Rotterdam criteria.…”

“…The SN procedure had been performed by the triple technique, which has been described elsewhere [23,33]. It consists of a preoperative lymphoscintigraphy, perioperative use of patent blue, and a hand-held g detection probe.…”