Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002–2009)

BMC Family Practice

François Aubin³  Philippe Humbert⁵  Fabien Pelletier⁵  Frances Sheppard²  Hatem Boulahdour¹  Delphine Delroeux⁶  Marc Puyraveau²  Eve Puzenat⁴  Caroline Biver-Dalle⁴ 

[1] Department of Nuclear Medicine, Besançon University Hospital, Besançon, France;Clinical Methodology Center, Besançon University Hospital, Besançon, France;Service de Dermatologie, 2 Place Saint-Jacques, 25030, Besançon, cedex, France;Department of Dermatology, Besançon University Hospital, Besançon, France;University of Franche Comté, UMR1098, SFR FED4234, Besançon, France;Department of Digestive Surgery, Besançon University Hospital, Besançon, France

关键词: Sentinel lymph node;    Melanoma;   

Others  :  855126
DOI  :  10.1186/1471-5945-12-21

 received in 2012-07-26, accepted in 2012-11-28,  发布年份 2012

【 摘 要 】

Background

Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.

Methods

A single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.

Results

The SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.

Conclusion

Our data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.

【 授权许可】

   
2012 Biver-Dalle et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al.: Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992, 127:392-399.
• [2]Lourari S, Paul C, Gouraud PA, Tavitian S, Viraben R, Leccia MT, et al.: Sentinel lymph node biopsy for melanoma is becoming a consensus: a national survey of French centres involved in melanoma care in 2008. J Eur Acad Dermatol Venereol 2012, 26:1230-1235.
• [3]Balch CM, Gershenwald JE, Soong S-J, Thompson JF, Atkins MB, Byrd DR, et al.: Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009, 27:6199-6206.
• [4]Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al.: Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006, 355:1307-1317.
• [5]Thomas JM: Freedom of expression or protectionism in the debate on sentinel node biopsy in melanoma. J Am Acad Dermatol 2009, 61:1079.
• [6]Saltman BE, Ganly I, Patel SG, Coit DG, Brady MS, Wong RJ, et al.: Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma. Head Neck 2010, 32:1686-1692.
• [7]Savoia P, Fava P, Caliendo V, Osella-Abate S, Ribero S, Quaglino P, Macripò G, Bernengo MG: Disease progression in melanoma patients with negative sentinel lymph node: does false-negative specimens entirely account for this phenomenon? J Eur Acad Dermatol Venereol 2012, 26:242-248.
• [8]Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al.: Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999, 17:976-983.
• [9]Gershenwald JE, Andtbacka RHI, Prieto VG, Johnson MM, Diwan AH, Lee JE, et al.: Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol 2008, 26:4296-4303.
• [10]Kunte C, Geimer T, Baumert J, Konz B, Volkenandt M, Flaig M, et al.: Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes. J Am Acad Dermatol 2011, 64:655-662. quiz 637
• [11]Rhodes AR: Prognostic usefulness of sentinel lymph node biopsy for patients who have clinically node negative, localized, primary invasive cutaneous melanoma: a Bayesian analysis using informative published reports. Arch Dermatol 2011, 147:408-415.
• [12]Testori A, De Salvo GL, Montesco MC, Trifirò G, Mocellin S, Landi G, et al.: Clinical considerations on sentinel node biopsy in melanoma from an Italian multicentric study on 1,313 patients (SOLISM-IMI). Ann Surg Oncol 2009, 16:2018-2027.
• [13]Wong SL, Morton DL, Thompson JF, Gershenwald JE, Leong SPL, Reintgen DS, et al.: Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 2006, 13:809-816.
• [14]Kretschmer L, Neumann C, Marsch WC, Lee RJ, et al.: Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 2000, 46:467-474. Int J Radiat Oncol Biol Phys 2000, 48: 1267–1268
• [15]Pasquali S, Mocellin S, Campana LG, Bonandini E, Montesco MC, Tregnaghi A, et al.: Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases: personal experience and literature meta-analysis. Cancer 2010, 116:1201-1209.
• [16]Gershenwald JE, Colome MI, Lee JE, Mansfield PF, Tseng C, Lee JJ, et al.: Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol 1998, 16:2253-2260.
• [17]van Akkooi AC, Voit CA, Verhoef C, Eggermont AM: New developments in sentinel node staging in melanoma: controversies and alternatives. Curr Opin Oncol 2010, 22:169-177.
• [18]Nieweg OE, Estourgie SH: What is a sentinel node and what is a false-negative sentinel node? Ann Surg Oncol 2004, 11(3 Suppl):169S-173S.
• [19]Veenstra HJ, Wouters MJWM, Kroon BBR, Olmos RAV, Nieweg OE: Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol 2011, 104:454-457.
• [20]Balch CM, Gershenwald JE, Soong S-J, Thompson JF, Ding S, Byrd DR, et al.: Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases. J Clin Oncol 2010, 28:2452-2459.
• [21]Kingham TP, Panageas KS, Ariyan CE, Busam KJ, Brady MS, Coit DG: Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy. Ann Surg Oncol 2010, 17:514-520.
• [22]Moroi Y: Significance of sentinel lymph node biopsy in malignant melanoma: overview of international data. Int J Clin Oncol 2009, 14:485-489.
• [23]van Akkooi ACJ, Nowecki ZI, Voit C, Schäfer-Hesterberg G, Michej W, de Wilt JHW, et al.: Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg 2008, 248:949-955.
• [24]van der Ploeg APT, van Akkooi ACJ, Rutkowski P, Nowecki ZI, Michej W, Mitra A, et al.: Prognosis in patients with sentinel node-positive melanoma is accurately defined by the combined Rotterdam tumor load and Dewar topography criteria. J Clin Oncol 2011, 29:2206-2214.
• [25]Cadili A, Scolyer RA, Brown PT, Dabbs K, Thompson JF: Total sentinel lymph node tumor size predicts nonsentinel node metastasis and survival in patients with melanoma. Ann Surg Oncol 2010, 17:3015-3020.
• [26]White RL Jr, Ayers GD, Stell VH, Ding S, Gershenwald JE, Salo JC, et al.: Factors predictive of the status of sentinel lymph nodes in melanoma patients from a large multicenter database. Ann Surg Oncol 2011, 18:3593-3600.
• [27]Scolyer RA, Li LX, McCarthy SW, Shaw HM, Stretch JR, Sharma R, et al.: Immunohistochemical stains fail to increase the detection rate of micrometastatic melanoma in completion regional lymph node dissection specimens. Melanoma Res 2004, 14:263-268.
• [28]Debarbieux S, Duru G, Dalle S, Béatrix O, Balme B, Thomas L: Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol 2007, 157:58-67.
• [29]Morton DL: Sentinel node mapping and an International Sentinel Node Society: Current issues and future directions. Ann Surg Oncol 2004, 11:137S-143S.
• [30]Kretschmer L, Thoms K-M, Peeters S, Haenssle H, Bertsch H-P, Emmert S: Postoperative morbidity of lymph node excision for cutaneous melanoma-sentinel lymphonodectomy versus complete regional lymph node dissection. Melanoma Res 2008, 18:16-21.
• [31]Voit CA, van Akkooi AJC, Schäfer-Hesterberg G, Sterry W, Eggermont AMM: Multimodality approach to the sentinel node: an algorithm for the use of presentinel lymph node biopsy ultrasound (after lymphoscintigraphy) in conjunction with presentinel lymph node biopsy fine needle aspiration cytology. Melanoma Res 2011, 21:450-456.