Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Berk, David R.; Johnson, Denise; Uzieblo, Alison; Kiernan, Michaela; Swetter, Susan M.

doi:10.1001/archderm.141.8.1016

Cited by 56 publications

(45 citation statements)

References 64 publications

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“…Because no patients with evidence of distant metastastic disease were found in the series of this study, the clinical staging was determined considering thickness and ulceration of primary tumor, as well as sentinel lymph node biopsy. The incidence of metastasis in the sentinel lymph node (14.6%) was similar to that previously reported by our own group and to that of other Caucasian melanoma series (9,39).…”

Section: Resultssupporting

confidence: 90%

Natural Killer Receptors on CD8 T Cells and Natural Killer Cells from Different HLA-C Phenotypes in Melanoma Patients

Campillo

Martínez‐Escribano

Moya‐Quiles

et al. 2006

Clinical Cancer Research

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Purpose: Because immune mechanisms involved in cutaneous melanoma have not been fully elucidated, efforts have been made to achieve prognosis markers and potential targets for immune therapies, but they have not been entirely fruitful thus far. Therefore, the goal of this study was to investigate the involvement of early changes in CD8 T cells and CD56 natural killer (NK) cells expressing NK receptors in different HLA-C dimorphism groups of melanoma patients. Experimental Design: CD8 T cells and CD56 NK cells were analyzed in 41 patients and 39 sex-and age-matched controls with different HLA-C genotypes by flow cytometry. HLA-C dimorphism at position 80 was tested by PCR sequence-specific primers and PCR sequencespecific oligonucleotide to examine whether it could mediate in the emergence of cells expressing killer cell immunoglobulin-like receptors. Results: Thirty-five of 41 patients had benign sentinel node, and showed an imbalance in the absolute number of CD8 +

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Section: Resultssupporting

confidence: 90%

Natural Killer Receptors on CD8 T Cells and Natural Killer Cells from Different HLA-C Phenotypes in Melanoma Patients

Campillo

Martínez‐Escribano

Moya‐Quiles

et al. 2006

Clinical Cancer Research

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“…25 • 27 • 36 -38 In our study we also found that Breslow thickness stratified according to the AJCC classification and ulceration were significantly correlated with SN positivity. Nodular melanoma was also a predictive factor of SN positivity which is consistent with Nowecki et al experience.…”

Section: • 23supporting

confidence: 64%

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Roulin

Matter

Bady

et al. 2008

European Journal of Surgical Oncology (EJSO)

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Aim: To confirm the accuracy of sentine! node biopsy (SNB) procedure and its morbidity, and to investigate predictive factors for SN status and prognostic factors for disease-free survival (DFS) and disease-specific survival (DSS). Materials and methods: Between October 1997 and December 2004, 327 consecutive patients in one centre with clinically node-negative primary skin melanoma underwent an SNB by the triple technique, i.e. lymphoscintigraphy, blue-dye and gamma-probe. Multivariate logistic regression analyses as well as the Kaplan-Meier were performed. Results: Twenty-three percent of the patients had at least one metastatic SN, which was significantly associated with Breslow thickness (p < 0.001). The success rate of SNB was 99.1 % and its morbidity was 7.6%. With a median follow-up of 33 months, the 5-year DFS/ DSS were 43%/49% for patients with positive SN and 83.5%/87.4% for patients with negative SN, respectively. The false-negative rate of SNB was 8.6% and sensitivity 91.4%. On multivariate analysis, DFS was significantly worsened by Breslow thickness (RR = 5.6, p < 0.001), positive SN (RR = 5.0, p < 0.001) and male sex (RR = 2.9, p = 0.001). The presence of a metastatic SN (RR = 8.4, p < 0.001), male sex (RR = 6.1,p < 0.001), Breslow thickness (RR = 3.2,p = 0.013) and ulceration (RR = 2.6,p = 0.015) were significantly associated with a poorer DSS. Conclusion: SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure. © 2007 Elsevier Ltd. All rights reserved.Keywords: Melanoma; Sentine! lymph node; Prognostic factors; Survival Introduction Sentinel node biopsy (SNB) is an important staging procedure and may be a potential therapeutic approach in the management of melanoma. Metastatic spreading from a primary melanoma can be explained by two possible theories. 1 In the "marker" hypothesis, the primary melanoma metastasizes * Corresponding author. Tel.: +41 21 314 23 54; fax: +41 2131428 51. E-mail address: maurice.matter@chuv.ch (M. Matter).0748-7983/$ -see front malter © 2007 Elsevier Ltd. Ali rights reserved. doi: 10.1016Ali rights reserved. doi: 10. /j.ejso.2007 simultaneously via lymphatic and haematogenous routes, so that the presence of regional lymph nodes metastases becomes a marker of the likelihood of systemic disease. In the "incubator" hypothesis, the primary melanoma targets regional lymph nodes where metastatic cells may survive and slowly grow but remain latent before spreading to distant sites. According to this second theory, it was suggested that early removal of involved regional lymph nodes in earlyand intermediate-stage melanoma could prevent the progression of the metastases and thus improve survival...

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“…Overall regional nodal and systemic recurrence of 5.0% in our study group during the 46 months follow-up period is quite similar to other recent published data (22,(24)(25)(26)(27)(28)(29). The false negative rate of 1.3% is less than 5% that is generally considered acceptable (28).…”

Section: Discussionsupporting

confidence: 90%

The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma

Vučetić

Rogan

Balenović

et al. 2006

Wien Klin Wochenschr

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(2006) The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma. Wiener klinische Wochenschrift, was performed four to six hours prior to operation of the patient. Sentinel lymph node biopsy using intraoperative hand-held gamma probe was performed in all patients, as well as wide local excision of biopsy wound or primary lesion (N=56). Immediate complete basin dissection was performed in patients with sentinel node metastases. In four patients delayed complete lymph node dissection was performed due to definitive histopathologic examination of sentinel node. The accuracy of sentinel node biopsy was determined by comparing the intraoperative rates of sentinel node identification and the subsequent development of nodal metastases in regional nodal basins of patients with tumor negative sentinel node and in those with tumor positive sentinel node.Results. By preoperative lymphoscintigraphy we identify sentinel node in all but one patient (99.0%). In 248 nodal basins (1.2/patient) 372 sentinel nodes (1.52 sentinel/basin; 1.8 sentinel/patient) were observed. The highest number of sentinel nodes was noticed in the groin of patients with melanoma on lower extremities (1.5/patient), followed by axilla with 1.3 per patient. Anomalous lymphatic drainage patterns were observed in 15.0% of all patients. Sentinel node identification rate was 99.0% overall; 100% for the groin basins, and 98.0% for the axilla and head and neck basin. Forty-two patients (20.8%) had tumor positive sentinel nodes. Local or distant recurrences had 10 (5.0%) patients during median follow up of 23.1 months (range 2-46 months). The rate of false-negative lymphatic mapping and 3 sentinel node biopsy as measured by nodal recurrence in a tumor-negative SN patients was 1.3%. During the follow-up period three of 201 patients died due to the other diseases and three patients died due to the melanoma metastases, with median follow up of 13.5 months (range 12 to 22). Conclusion.Preoperative lymphoscintigraphy is sensitive, inexpensive and essential method for the identification of drainage basins, determination of number and position of sentinel node and its location outside the usual nodal basins. Scintigraphic findings may lead to changes in surgical management due to the unpredictability of lymphatic drainage. Low incidence of regional disease recurrence in patients with tumor negative sentinel node supports the use of preoperative lymphoscintigraphy and sentinel node biopsy as a safe and accurate procedure for staging the regional nodal basin in patients with malignant melanoma.

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Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Cited by 56 publications

References 64 publications

Natural Killer Receptors on CD8 T Cells and Natural Killer Cells from Different HLA-C Phenotypes in Melanoma Patients

Natural Killer Receptors on CD8 T Cells and Natural Killer Cells from Different HLA-C Phenotypes in Melanoma Patients

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma

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