Sentinel Lymphadenectomy Does Not Increase the Incidence of In-Transit Metastases in Primary Melanoma

Kang, John; Wanek, Leslie A.; Essner, Richard; Faries, Mark B.; Foshag, Leland J.; Morton, Donald L.

doi:10.1200/jco.2005.20.537

Cited by 66 publications

(41 citation statements)

References 18 publications

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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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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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“…Lymphatic mapping and selective SLN excision in patients with melanoma is a minimally invasive procedure, which allows for the identification of patients at-risk for lymph node metastasis who should undergo a full therapeutic tumordraining lymph node dissection. Recent studies have confirmed the SLN procedure to be safe and offers a possible survival benefit (23,24,43). Routine application of this procedure in patients with early stage melanoma presents a unique translational setting to study adjuvant therapies in vivo aimed at the potentiation of immune reactivity within the SLN.…”

Section: Discussionmentioning

confidence: 99%

Tumor-Specific CD8+ T Cell Reactivity in the Sentinel Lymph Node of GM-CSF–Treated Stage I Melanoma Patients is Associated with High Myeloid Dendritic Cell Content

Vuylsteke

Molenkamp²,

Leeuwen³

et al. 2006

Clinical Cancer Research

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Purpose: Impaired immune functions in the sentinel lymph node (SLN) may facilitate early metastatic events during melanoma development. Local potentiation of tumor-specificTcell reactivity may be a valuable adjuvant treatment option. Experimental Design: We examined the effect of locally administered granulocyte/macrophage-colony stimulating factor (GM-CSF) on the frequency of tumor-specific CD8+ T cells in the SLN and blood of patients with stage I melanoma. Twelve patients were randomly assigned to preoperative local administration of either recombinant human GM-CSF or NaCl 0.9%. CD8+ Tcells from SLN and peripheral blood were tested for reactivity in an IFNg ELISPOTassay against the full-length MART-1 antigen and a number of HLA-A1, HLA-A2, and HLA-A3^restricted epitopes derived from a range of melanoma-associated antigens. Results: Melanoma-specific CD8+ Tcell response rates in the SLN were one of six for the control group and four of six for the GM-CSF-administered group. Only one patient had detectable tumor-specific CD8+ T cells in the blood, but at lower frequencies than in the SLN. All patients with detectable tumor-specific CD8+ T cells had a percentage of CD1a+ SLN-dendritic cells (DC) above the median (i.e., 0.33%). This association between above median CD1a+ SLN-DC frequencies and tumor antigen^specific CD8+ T cell reactivity was significant in a two-sided Fisher's exact test (P = 0.015). Conclusions: Locally primed antitumor T cell responses in the SLN are detectable as early as stage I of melanoma development and may be enhanced by GM-CSF-induced increases in SLN-DC frequencies.

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“…It has been suggested that SNB could increase the risk of in-transit metastasis and recurrence rates [31,32]; however the current available evidence, including a randomized controlled trail, has demonstrated that this is not a genuine concern [33][34][35][36], with an explanation leading towards a more aggressive tumor biology in these patients than attributable to the SNB.…”

Section: Accurate Staging and Defining Prognosismentioning

confidence: 86%

Advocating Sentinel Node Biopsy in the Management of Cutaneous Melanoma

2012

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Sentinel Lymphadenectomy Does Not Increase the Incidence of In-Transit Metastases in Primary Melanoma

Cited by 66 publications

References 18 publications

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

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

Tumor-Specific CD8+ T Cell Reactivity in the Sentinel Lymph Node of GM-CSF–Treated Stage I Melanoma Patients is Associated with High Myeloid Dendritic Cell Content

Advocating Sentinel Node Biopsy in the Management of Cutaneous Melanoma

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