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Review and Evaluation of Sentinel Node Procedures in 250 Melanoma Patients With a Median Follow-Up of 6 Years

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Abstract

Background: The aim of this study was to evaluate the results of sentinel node biopsy in cutaneous melanoma at our institute.

Methods: A total of 250 patients with cutaneous melanoma were studied prospectively. Preoperative lymphoscintigraphy was performed after injection of 99mTc-nanocolloid intradermally around the primary tumor or biopsy site (.32 mL, 65.5 MBq [1.8 mCi]). The sentinel node was surgically identified with the aid of patent blue dye and a gamma ray detection probe. The median follow-up was 72 months.

Results: Lymphoscintigraphic visualization was 100%, and surgical identification was 99.6%. In 60 patients (24%), 1 or more sentinel nodes were tumor positive at initial pathology evaluation. Late complications after sentinel node biopsy of the remaining 190 patients were seen in 35 patients (18%). The false-negative rate was 9%. In-transit metastases were seen in 7% of sentinel node–negative and 23% of sentinel node–positive patients. The estimated 5-year overall survival rates were 89% and 64%, respectively (P < .001).

Conclusions: This study confirms that the status of the sentinel node is a strong independent prognostic factor. The false-negative rate and the incidence of in-transit metastases in sentinel node–positive patients are high and have to be weighed against the possible survival benefit of early removal of nodal metastases.

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REFERENCES

  1. Cochran AJ, Balda BR, Starz H, et al. The Augsburg Consensus. Techniques of lymphatic mapping, sentinel lymphadenectomy, and completion lymphadenectomy in cutaneous malignancies. Cancer 2000; 89:236–41.

    Article  PubMed  CAS  Google Scholar 

  2. Gershenwald JE, Thompson W, Mansfield PF, 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; 17:976–83.

    PubMed  CAS  Google Scholar 

  3. Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg 2000; 87:484–9.

    Article  PubMed  CAS  Google Scholar 

  4. Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma. A multicenter trial. Ann Surg 1999; 230:453–65.

    Article  PubMed  CAS  Google Scholar 

  5. Nieweg OE, Tanis PJ, Rutgers EJ. Summary of the Second International Sentinel Node Conference. Eur J Nucl Med 2001; 28:646–9.

    Article  PubMed  CAS  Google Scholar 

  6. Nieweg OE, Tanis PJ, De Vries JD, et al. Sensitivity of sentinel node biopsy in melanoma. J Surg Oncol 2001; 78:223–4.

    Article  PubMed  CAS  Google Scholar 

  7. Punt CJ, Eggermont AM. Adjuvant interferon-alpha for melanoma revisited: news from old and new studies. Ann Oncol 2001; 12:1663–6.

    Article  PubMed  CAS  Google Scholar 

  8. Nieweg OE, Tanis PJ, Kroon BBR. The definition of a sentinel node. Ann Surg Oncol 2001; 8:538–41.

    Article  PubMed  CAS  Google Scholar 

  9. Jacobs IA, Chevinsky AH, Swayne LC, et al. Gamma probe-directed lymphatic mapping and sentinel lymphadenectomy in primary melanoma: reliability of the procedure and analysis of failures after long-term follow-up. J Surg Oncol 2001; 77:157–64.

    Article  PubMed  CAS  Google Scholar 

  10. Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO melanoma program experience. Ann Surg Oncol 2000; 7:469–74.

    Article  PubMed  CAS  Google Scholar 

  11. Clary BM, Brady MS, Lewis JJ, et al. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg 2001; 233:250–8.

    Article  PubMed  CAS  Google Scholar 

  12. Doting MHE, Hoekstra HJ, Plukker JT, et al. Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma. Eur J Surg Oncol 2002; 28:673–8.

    Article  PubMed  CAS  Google Scholar 

  13. Gershenwald JE, Schacherer C, Emerson M, et al. Patterns of failure and survival analysis in sentinel lymph node positive melanoma patients. Proc Am Soc Clin Oncol 2001.

  14. Harlow SP, Krag DN, Ashikaga T, et al. Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre study. Melanoma Res 2001; 11:45–55.

    Article  PubMed  CAS  Google Scholar 

  15. Thomas JM, Patocskai EJ. The argument against sentinel node biopsy for malignant melanoma. BMJ 2000; 321:3–4.

    Article  PubMed  CAS  Google Scholar 

  16. Tanis PJ, Nieweg OE, Hart AA, et al. The illusion of the learning phase for lymphatic mapping. Ann Surg Oncol 2002; 9:142–7.

    Article  PubMed  CAS  Google Scholar 

  17. Nieweg OE, Jansen L, Kroon BBR. Technique of lymphatic mapping and sentinel node biopsy for melanoma. Eur J Surg Oncol 1998; 24:520–4.

    Article  PubMed  CAS  Google Scholar 

  18. Statius Muller MG, Borgstein PJ, Pijpers R, et al. Reliability of the sentinel node procedure in melanoma patients: analysis of failures after long-term follow-up. Ann Surg Oncol 2000; 7:461–8.

    Article  PubMed  CAS  Google Scholar 

  19. Kapteijn BAE, Nieweg OE, Valdés Olmos RA, et al. Reproducibility of lymphoscintigraphy for lymphatic mapping in cutaneous melanoma. J Nucl Med 1996; 37:972–5.

    PubMed  CAS  Google Scholar 

  20. Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg 2001; 192:399–409.

    Article  PubMed  CAS  Google Scholar 

  21. Starz H, Balda BR, Kramer KU, et al. A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001; 91:2110–21.

    Article  PubMed  CAS  Google Scholar 

  22. Balch CM, Soong S, Ross MI, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol 2000; 7:87–97.

    Article  PubMed  CAS  Google Scholar 

  23. Cascinelli N, Morabito A, Santinami M, et al. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet 1998; 351:793–6.

    Article  PubMed  CAS  Google Scholar 

  24. Eggermont AM, Keilholz U, Testori A, et al. The EORTC melanoma group translational research program on prognostic factors and ultrastaging in association with the adjuvant therapy trials in stage II and stage III melanoma. European Organization for Research and Treatment of Cancer. Ann Surg Oncol 2001; 8:38S–40S.

    Article  PubMed  CAS  Google Scholar 

  25. McMasters KM. The Sunbelt Melanoma Trial. Ann Surg Oncol 2001; 8:41S–43S.

    Article  PubMed  CAS  Google Scholar 

  26. Dubois RW, Swetter SM, Atkins M, et al. Developing indications for the use of sentinel lymph node biopsy and adjuvant high-dose interferon alfa-2b in melanoma. Arch Dermatol 2001; 137:1217–24.

    PubMed  CAS  Google Scholar 

  27. Wheatley K, Ives N, Hancock B, et al. Need for a quantitative meta-analysis of trials of adjuvant interferon in melanoma. J Clin Oncol 2002; 20:4120–2.

    Article  PubMed  Google Scholar 

  28. Cimmino VM, Brown AC, Szocik JF, et al. Allergic reactions to isosulfan blue during sentinel node biopsy—a common event. Surgery 2001; 130:439–42.

    Article  PubMed  CAS  Google Scholar 

  29. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: controversy despite widespread agreement. J Clin Oncol 2001; 19:2851–5.

    PubMed  CAS  Google Scholar 

  30. Statius Muller MG, van Leeuwen PA, Van Diest PJ, et al. Pattern and incidence of first site recurrences following sentinel node procedure in melanoma patients. World J Surg 2002; 26:1405–11.

    Article  PubMed  Google Scholar 

  31. Calabro A, Singletary SE, Balch CM. Patterns of relapse in 1001 consecutive patients with melanoma nodal metastases. Arch Surg 1989; 124:1051–5.

    PubMed  CAS  Google Scholar 

  32. Essner R, Conforti A, Kelley MC, et al. Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999; 6:442–9.

    Article  PubMed  CAS  Google Scholar 

  33. Clary BM, Mann B, Brady MS, et al. Early recurrence after lymphatic mapping and sentinel node biopsy in patients with primary extremity melanoma: a comparison with elective lymph node dissection. Ann Surg Oncol 2001; 8:328–37.

    Article  PubMed  CAS  Google Scholar 

  34. Statius Muller MG, van Leeuwen PA, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with Stage I or II cutaneous melanoma. Cancer 2001; 91:2401–8.

    Article  PubMed  CAS  Google Scholar 

  35. Ferrone CR, Panageas KS, Busam K, et al. Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status. Ann Surg Oncol 2002; 9:637–45.

    Article  PubMed  Google Scholar 

  36. Dessureault S, Soong SJ, Ross MI, et al. Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol 2001; 8:766–70.

    Article  PubMed  CAS  Google Scholar 

  37. Eggermont AM. Adjuvant therapy of malignant melanoma and the role of sentinel node mapping. Recent Results Cancer Res 2000; 157:178–89.

    PubMed  CAS  Google Scholar 

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Correspondence to Susanne H. Estourgie MD.

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Estourgie, S.H., Nieweg, O.E., Valdés Olmos, R.A. et al. Review and Evaluation of Sentinel Node Procedures in 250 Melanoma Patients With a Median Follow-Up of 6 Years. Ann Surg Oncol 10, 681–688 (2003). https://doi.org/10.1245/ASO.2003.01.023

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  • DOI: https://doi.org/10.1245/ASO.2003.01.023

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