Article

Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis.

Thomas Jefferson University, Philadelphia, PA, USA.
Journal of Clinical Oncology (impact factor: 18.37). 03/2011; 29(11):1479-87. DOI:10.1200/JCO.2010.33.1884
Source: PubMed

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.

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Keywords

71 studies
 
average PSM
 
complete lymph node dissection
 
deeper Breslow thickness
 
false-negative rate
 
female sex
 
full eligibility criteria
 
greater PSM
 
negative SLN biopsy
 
nodal basin
 
nodal basin recurrence
 
nodal recurrence
 
positive predictive value
 
positive SLN
 
post-test probability negative
 
Published literature
 
quality score
 
sentinel lymph node
 
test performance
 
younger age