Utility of Multistep Protocols in the Analysis of Sentinel Lymph Nodes in Cutaneous Melanoma: An Assessment of 194 Cases

Abstract

Context.— Currently, no universal protocol exists for the assessment of sentinel lymph nodes (SLNs) in cutaneous melanoma. Many institutions use a multistep approach with multiple hematoxylin-eosin (H&E) and immunohistochemical stains. However, this can be a costly and time- and resource-consuming task. Objective.— To assess the utility for multistep protocols in the analysis of melanoma SLNs by specifically evaluating the Calgary Laboratory Services (CLS) protocol (which consists of 3 H&E slides and 1 S100 protein, 1 HMB-45, and 1 Melan-A slide per melanoma SLN block) and to develop a more streamlined protocol. Design.— Histologic slides from SLN resections from 194 patients with diagnosed cutaneous melanoma were submitted to the CLS dermatopathology group. Tissue blocks were processed according to the CLS SLN protocol. The slides were re-reviewed to determine whether or not metastatic melanoma was identified microscopically at each step of the protocol. Using SPSS software, a decision tree was then created to determine which step most accurately reflected the true diagnosis. Results.— We found with Melan-A immunostain that 337 of 337 negative SLNs (100%) were correctly diagnosed as negative and 55 of 56 positive nodes (98.2%) were correctly diagnosed as positive. With the addition of an H&E level, 393 of 393 SLNs (100%) were accurately diagnosed. Conclusions.— We recommend routine melanoma SLN evaluation protocols be limited to 2 slides: 1 H&E stain and 1 Melan-A stain. This protocol is both time- and cost-efficient and yields high diagnostic accuracy.

Effect of Occupational Health and Safety Training for Chinese Construction Workers Based on the CHAID Decision Tree

“…The decision tree intelligent discriminant analysis method is a kind of classification regression tree algorithm (45), which is widely used in medical diagnosis (46), biological analysis (47), deep learning (48) and optical application analysis (49), and also has many applications in data comparative analysis (50) and classification importance analysis (51). In the field of engineering, the decision tree is mainly used in equipment improvement (52), geotechnical engineering special new analysis ( 53), building damage assessment (54), and engineering modeling (55).…”

Sentinel lymph node assessment in melanoma: current state and future directions

“…Currently, institutional protocol for histopathological handling of sentinel lymph nodes and pathological reporting varies widely. 68,128,129,130,131,132 Macroscopically, two main methods of slicing sentinel lymph nodes exists: 'breadloafing', allowing for better examination of the subcapsular region, and bivalving, allowing for better examination of lymphatic vessels. 130,131 Both the European Organisation for Research and Treatment of Cancer (EORTC) and Sydney Melanoma Unit recommend the utilisation of the bivalving technique in sentinel lymph node histopathological and handling protocol.…”

“…137 A retrospective study found, utilising a decision tree, that limiting SLN evaluation protocols to two slides of one H&E stain and one Melan-A stain has similar diagnostic accuracy as a protocol incorporating multiple H&E, S100 and HMB-45 stains in addition to those two slides. 132 With the recent discovery that patients who receive CLND do not have a survival advantage over those who undergo observation, further refinement of prognostication is imperative to help improve survival outcomes through determination of appropriate adjuvant treatment beyond observation if necessary. Currently, a 31-gene expression profile (31-GEP) test for cutaneous melanoma has been developed and is currently being evaluated for its utility in clarifying prognosis in AJCC-classified low-risk melanoma and clarifying the wide range of prognosis reported for AJCC stages 2 and 3 patients.…”

Refining diagnosis is the prerequisite for the correct treatment: The cytodiagnostic utility of SOX10 in the diagnosis of metastatic melanoma

“…HMB-45, Melan-A, S-100, cytoplasmic markers for melanocytes, are frequently used immunocytochemical markers in cytology practice. However, their sensitivity has been demonstrated to be suboptimal, and their expression rates may be lower in metastatic lesions 3,4. SOX10, a nuclear marker, is considered more reliable than cytoplasmic and membranous markers.…”

“…However, their sensitivity has been demonstrated to be suboptimal, and their expression rates may be lower in metastatic lesions. 3,4 SOX10, a nuclear marker, is considered more reliable than cytoplasmic and membranous markers. Nevertheless, as it may also show positivity in breast carcinoma and spindle cell neoplasms, it should not be used as a sole determinant of melanocytic origin.…”