Sentinel lymph node micrometastasis may predict non‐sentinel involvement in cutaneous melanoma patients
ABSTRACT Cutaneous melanoma patients with positive sentinel lymph node biopsy (SLNB) are being treated with completion lymph node dissection (CLND). The aim of our study was to determine the predictive value of sentinel lymph node (SLN) micrometastases (metastases less than 2 mm in diameter) in assessing further lymph node involvement in CLND.
Between 2001 and 2005, we performed 476 SLNB in patients with stages I and II melanoma; 74 had metastases in SLN. We evaluated retrospectively the metastases in SLN according to their size and number. The presence of additional metastases in non-sentinel lymph nodes after CLND was evaluated.
Thirty-nine patients had micrometastases, 22 of them were solitary, 3 were double, and 14 patients had multiple micrometastases in SLN. Out of 22 solitary micrometastases, no patient had additional metastases in non-sentinel lymph nodes. From 3 patients with double micrometastases, 1 patient had further metastases in non-sentinel lymph nodes after CLND. Out of 14 patients with multiple micrometastases, 2 had additional metastases in CLND.
No patient with a single SLN micrometastasis had further metastases after CLND in our series. CLND may not be beneficial after detecting a single micrometastasis in SLN.
SourceAvailable from: Alexander Christopher Jonathan van Akkooi[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE OF REVIEW: Sentinel node biopsy (SNB) for primary melanoma is accepted worldwide as a diagnostic procedure. When sentinel node positive, the invasive completion lymph node dissection (CLND) is usually performed. Approximately 20% of CLND patients have nonsentinel node (NSN) metastases. The therapeutic benefit is unknown. This review analyzed the necessity of CLND in sentinel node positive patients. RECENT FINDINGS: Prognosis of sentinel node positive patients is highly heterogeneous. The Rotterdam and Dewar criteria and S-classification are important sentinel node tumor burden criteria to stratify melanoma patients for prognosis and risk of NSN metastases. Patients with less than 0.1 mm metastases seem to have similar prognosis as sentinel node negative patients, especially when located in the subcapsular area. This depends on the use of an extensive sentinel node pathology protocol identifying possibly clinically irrelevant micrometastases. SUMMARY: Consensus on the sentinel node pathology work-up and analysis protocols are crucial for correct risk stratification and for clinical decision-making. Primary and sentinel node tumor burden parameters and patient comorbidities should be taken into consideration when offering CLND to an individual patient. In the future, prospective studies such as the MSLT-II and the EORTC 1208 (Minitub) will provide answers to whether CLND has a therapeutic benefit and to which patients might safely be spared CLND.Current opinion in oncology 01/2013; DOI:10.1097/CCO.0b013e32835dafb4 · 3.76 Impact Factor
Article: Professor Nils RingertzCell Biology International 06/2003; 27(6):449-450. DOI:10.1016/S1065-6995(03)00076-3 · 1.64 Impact Factor
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ABSTRACT: BACKGROUND: The current recommendation for patients with cutaneous melanoma and a positive sentinel lymph node (SLN) biopsy is a complete lymph node dissection (CLND). However, metastatic melanoma is not present in approximately 80% of CLND specimens. A meta-analysis was performed to identify the clinicopathological variables most predictive of non-sentinel node (NSN) metastases when the sentinel node is positive in patients with melanoma. METHODS: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google scholar, Science Direct, and Web of Science. The search identified 54 relevant articles reporting the frequency of NSN metastases in melanoma. Original data was abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). FINDINGS: The pooled estimates that were found to be significantly associated with the high likelihood of NSN metastases were: ulceration (OR: 1.88, 95% CI: 1.53-2.31), satellitosis (OR: 3.25, 95% CI: 1.86-5.66), neurotropism (OR: 2.51, 95% CI: 1.39-4.53), >1 positive SLN (OR: 1.77, 95% CI: 1.2-2.62), Starz 3 (old) (OR: 1.83, 95% CI: 0.89-3.76), Angiolymphatic invasion (OR: 2.46, 95% CI: 1.34-4.54), extensive location (OR: 2.22, 95% CI: 1.74-2.81), macrometastases >2 mm (OR: 1.95, 95% CI: 1.61-2.35), extranodal extension (OR: 3.38, 95% CI: 1.79-6.40) and capsular involvement (OR: 3.16, 95% CI: 1.37-7.27). There were 3 characteristics not associated with NSN metastases: subcapsular location (OR: 0.51, 95% CI: 0.38-0.67), Rotterdam Criteria <0.1 mm (OR: 0.29, 95% CI: 0.17-0.50) and Starz I (new) (OR: 0.44, 95% CI: 0.22-0.91). Other variables including gender, Breslow thickness 2-4 mm and extremity as primary site were found to be equivocal. INTERPRETATION: This meta-analysis provides evidence that patients with low SLN tumor burden could probably be spared the morbidity associated with CLND. We identified 9 factors predictive of non-SLN metastases that should be recorded and evaluated routinely in SLN databases. However, further studies are needed to confirm the standard criteria for not performing CLND.European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 04/2013; 39(7). DOI:10.1016/j.ejso.2013.02.022 · 2.89 Impact Factor