Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis.
ABSTRACT To perform a meta-analysis of all published studies of sentinel lymph node (SLN) biopsy for staging patients with melanoma.
Published literature in all languages between 1990 and 2009 was critically appraised. Primary outcomes evaluated included the proportion successfully mapped (PSM) and test performance including false-negative rate (FNR), post-test probability negative (PTPN), and positive predictive value in the same nodal basin recurrence.
A total of 71 studies including 25,240 patients met full eligibility criteria. The average PSM was 98.1% (95% CI, 97.3% to 98.6%) and increased with the year of publication, female sex, ulceration, age, and the quality score of the studies. The FNR ranged from 0.0% to 34.0%, averaging 12.5% overall (95% CI, 11% to 14.2%). FNR increased with the length of follow-up (P = .002) but decreased with greater PSM (P = .001). PTPN averaged 3.4% (95% CI, 3.0% to 3.8%), which also increased in studies with longer follow-up, younger age, female sex, deeper Breslow thickness, and with tumor ulceration while decreasing with greater PSM (P < .001). Approximately 20% of the patients with a positive SLN had additional lymph nodes in the complete lymph node dissection and 7.5% of the patients with positive SLN developed recurrence in the same nodal basin which was greater in studies that also reported higher FNR (P = .01).
The estimated risk of nodal recurrence after a negative SLN biopsy was ≤ 5% supporting the use of this technology for staging patients with melanoma.
European Journal of Nuclear Medicine 01/2012; 39(1):1-3. · 4.53 Impact Factor
Article: Comparison of the use and results of sentinel lymph node biopsy in children and young adults with melanoma.[show abstract] [hide abstract]
ABSTRACT: Data on sentinel lymph node (SLN) biopsy in children with melanoma are limited. In this study, the authors compared the factors associated with SLN biopsy use and metastases in pediatric and young adult patients with melanoma. The 2008 Surveillance, Epidemiology, and End Results (SEER) databases were used to examine melanoma cases from 2003 to 2008. Data extracted include age, sex, race, stage, tumor thickness, ulceration, lymph node status, surgical treatment, and survival. Logistic regression models were used for adjusted analyses. In total, 717 children (age <20 years) and 1368 young adults (age 20-24 years) were identified who were diagnosed with melanoma. Factors that were associated with SLN biopsy use included tumor ulceration (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.4-4.3) and greater thickness (OR, 17; 95% CI, 12-24 for >1 mm vs ≤1 mm), but not younger age (OR, 1.3; 95% CI, 0.94-1.8) in adjusted analyses. SLN metastasis was correlated with ulceration (OR, 3.0; 95% CI, 1.6-5.8), increased thickness (OR, 6.8; 95% CI, 3.1-15 for 2.01-4.0 mm vs ≤1 mm), and for the interaction between age <20 years and thickness 1.01 to 2.00 mm (OR, 6.5; 95% CI, 1.7-25) in adjusted analyses. Children with nonulcerated melanomas that measured 1.01 to 2.00 mm in thickness were significantly more likely to have SLN metastases than young adults (24% vs 4%; P < .001). Thickness and ulceration were strong predictors of both the use of SLN biopsy and positive SLN biopsy results in children and young adults with melanoma. Compared with young adults, children were more likely to have SLN metastases despite having similar rates of SLN biopsy use.Cancer 05/2012; 118(10):2700-7. · 4.77 Impact Factor