Time to reconsider the role of sentinel lymph node biopsy in melanoma

Bigby, Michael; Zagarella, Samuel; Sladden, Michael J; Popescu, C

doi:10.1016/j.jaad.2018.11.026

Cited by 21 publications

(22 citation statements)

References 16 publications

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“…skin cancer dataset for primary cutaneous invasive squamous cell carcinoma. 3 Therefore, we disagree with the explanation by Slater that our observed differences between Mohs micrographic surgery and standard excision in recurrence rate (3% vs. 8%) is caused by the poor quality of pathological sampling of excision specimens. The lower risk of recurrence after Mohs micrographic surgery than standard excision is most likely caused by the fact that with Mohs micrographic surgery the entire excision margins are histologically reviewed.…”

contrasting

confidence: 94%

“…Sentinel lymph node biopsy (SLNB) is still young and there is less experience than with the pathological criteria of Breslow thickness and ulceration. 3 The sensitivity, specificity, positive predictive value and negative predictive value of sentinel lymph node status on overall 10-year mortality based on Multicenter Selective Lymphadenectomy Trial I intention-to-treat data were 33%, 87%, 26% and 90%, respectively. 2 The vast majority of patients with melanoma have a negative SLNB and cannot possibly benefit from the procedure.…”

Section: Referencesmentioning

confidence: 94%

“…1 We do not accept this claim. 3 SLNB has poor test performance characteristics. SLNB provides no survival benefit for patients with melanoma and results in complications, including 6% risk of lymphoedema.…”

Section: Referencesmentioning

confidence: 99%

“…There is no clear evidence that SLNB provides better prognostic information than Breslow thickness and ulceration. 3 SLNB has poor test performance characteristics. 3 The sensitivity, specificity, positive predictive value and negative predictive value of sentinel lymph node status on overall 10-year mortality based on Multicenter Selective Lymphadenectomy Trial I intention-to-treat data were 33%, 87%, 26% and 90%, respectively.…”

mentioning

confidence: 99%

“…3 SLNB has poor test performance characteristics. 3 The sensitivity, specificity, positive predictive value and negative predictive value of sentinel lymph node status on overall 10-year mortality based on Multicenter Selective Lymphadenectomy Trial I intention-to-treat data were 33%, 87%, 26% and 90%, respectively. 4 We are surprised by the comment that actuarial estimates, as opposed to real-trial evidence, are now being promoted as evidence-based dermatology.…”

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confidence: 99%

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The sentinel node biopsy has not come of age

et al. 2019

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confidence: 94%

Section: Referencesmentioning

confidence: 94%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The sentinel node biopsy has not come of age

et al. 2019

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Sentinel Lymph Node Biopsy in Cutaneous Melanoma—Where Do We Stand?

Marchetti

Bartlett

2021

JAMA Dermatol

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There are few procedures as controversial as the sentinel lymph node biopsy (SLNB) in the treatment of cutaneous melanoma. Early proponents hypothesized it would improve patient outcomes and provide valuable prognostic information. The Multicenter Selective Lymphadenectomy Trial (MSLT-1), 1 however, demonstrated that addition of SLNB to wide excision did not improve melanoma-specific survival (MSS). The MSLT-2 trial and the German Dermatologic Cooperative Oncology Group trials 1 further showed that among patients with a positive SLNB, completion lymph node dissection (CLND) did not improve MSS or overall survival (OS), respectively. Although controversy persists regarding a potential reduction in MSS in selected subgroup analyses of patients with intermediate-thickness melanoma, the findings from these trials redefined the primary role of SLNB to that of a prognostic test, which subsequent adjuvant therapy trials have used as eligibility criteria for systemic therapy.In MSLT-1, the SLNB was interpreted as the strongest predictor of disease recurrence or death from melanoma. 1 Bigby et al, 2 however, questioned the contemporary role of the SLNB, noting that the added prognostic value of SLNB status to standard clinicopathological factors remains unproven. To address this need, El Sharouni et al 3 recently characterized the added prognostic utility of SLNB. The authors created clinicopathological only (CP) (based on tumor thickness, sex, age, anatomical site, mitoses, ulceration, regression, and subtype) and clinicopathological plus SLNB (CP-SLN) prediction models from a cohort of 9272 Dutch patients and validated the models' performance in 5644 Australian patients. Similar to MSLT-1, 4 SLNB status was a robust predictor of recurrence-free survival (hazard ratio, 2.7). In addition, the CP-SLN model had higher discrimination (area under the curve) than the CP model for prediction of all survival outcomes, underscoring the prognostic validity of SLNB.However, these data do not tell us whether the information gained from SLNB leads to better treatment choices. For this, decision curve analysis was used by El Sharouni et al 3 to investigate SLNB's clinical utility. To interpret a decision curve, one needs to specify a risk threshold for a particular melanoma treatment. Although risk thresholds are poorly quantified, some US clinicians would obtain cross-sectional imaging (eg, computed tomographic scan) for a patient with American Joint Committee on Cancer Staging Manual, 8th Edition, stage IIB-positive disease (approximately 87% MSS), as National Comprehensive Care Network (NCCN) guidelines state to consider imaging in this population for occult metastatic disease. This suggests that an ap-VIEWPOINT

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Raman Nanotags‐Guided Intraoperative Sentinel Lymph Nodes Precise Location with Minimal Invasion

Deng

Wang

et al. 2021

Advanced Science

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The accurate positioning of sentinel lymph node (SLN) by tracers during surgery is an important prerequisite for SLN biopsy. A major problem of traditional tracers in SLN biopsy is the short surgery window due to the fast diffusion of tracers through the lymphatics, resulting in a misjudgment between SLN and second echelon lymph node (2nd LN). Here, a nontoxic Raman nanoparticle tracer, termed gap‐enhanced Raman tags (GERTs), for the accurate intraoperative positioning of SLNs with a sufficient surgical time window is designed. In white New Zealand rabbit models, GERTs enable precise identification of SLNs within 10 min, as well as provide the surgeon with a more than 4 h time window to differentiate SLN and 2nd LN. In addition, the ultrahigh sensitivity of GERTs (detection limit is 0.5 × 10−12 m) allows detection of labeled SLNs before surgery, thereby providing preoperative positioning information for minimally invasive surgery. Comprehensive biosafety evaluations carried out in the context of the Food and Drug Administration and International Standard Organization demonstrate no significant toxicity of GERTs, which supports a promising clinical translation opportunity of GERTs for precise SLN identification in breast cancer.

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Time to reconsider the role of sentinel lymph node biopsy in melanoma

Cited by 21 publications

References 16 publications

The sentinel node biopsy has not come of age

The sentinel node biopsy has not come of age

Sentinel Lymph Node Biopsy in Cutaneous Melanoma—Where Do We Stand?

Raman Nanotags‐Guided Intraoperative Sentinel Lymph Nodes Precise Location with Minimal Invasion

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