Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients
- Charles R. Scoggins MD, MBA,
- Robert C. G. Martin MD, PhD,
- Merrick I. Ross MD,
- Michael J. Edwards MD,
- Douglas S. Reintgen MD,
- Marshall M. Urist MD,
- Jeffrey E. Gershenwald MD,
- Jeffrey J. Sussman MD,
- R. Dirk Noyes MD,
- James S. Goydos MD,
- Peter D. Beitsch MD,
- Stephan Ariyan MD,
- Arnold J. Stromberg PhD,
- Lee J. Hagendoorn MBA,
- Kelly M. McMasters MD, PhD
- … show all 15 hide
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Some melanoma patients who undergo sentinel lymph node (SLN) biopsy will have false-negative (FN) results. We sought to determine the factors and outcomes associated with FN SLN biopsy.
Analysis was performed of a prospective multi-institutional study that included patients with melanoma of thickness > 1.0 mm who underwent SLN biopsy. FN results were defined as the proportion of node-positive patients who had a tumor-negative sentinel node biopsy. Kaplan–Meier survival analysis and univariate and multivariate analyses were performed.
This analysis included 2,451 patients with median follow-up of 61 months. FN, true-positive (TP), and true-negative (TN) SLN results were found in 59 (10.8%), 486 (19.8%), and 1,906 (77.8%) patients, respectively. On univariate analysis comparing the FN with TP groups, respectively, the following factors were significantly different: age (52.6 vs. 47.6 years, p = 0.004), thickness (mean 2.1 vs. 3.1 mm, p = 0.003), lymphovascular invasion (LVI; 3.7 vs. 13.7%, p = 0.037), and local/in-transit recurrence (LITR; 32.2 vs. 12.4%, p < 0.0001); these factors remained significant on multivariate analysis. Overall 5-year survival was greater in the TN group (86.7%) compared with the TP (62.3%) and FN (51.3%) groups (p < 0.0001); however, there was no significant difference in overall survival comparing the TP and FN groups (p = 0.32).
This is the largest study to evaluate FN SLN results in melanoma, with a FN rate of 10.8%. FN results are associated with greater patient age, lower mean thickness, less frequent LVI, and greater risk of LITR. However, survival of patients with FN SLN is not statistically worse than that of patients with TP SLN.
- American Cancer Society. Cancer Facts and Figures, 2007. 2007.
- Chao C, Wong SL, Edwards MJ, et al. Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol. 2003;10:21–6. CrossRef
- Chao C, Martin RC, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11:259–264. CrossRef
- McMasters KM. Multiple nodal basin drainage in truncal melanomas. Ann Surg Oncol. 2000;7:249–250. CrossRef
- McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol. 2004;86:212–23. CrossRef
- Scoggins CR, Ross MI, Reintgen DS, et al. Gender-related differences in outcome for melanoma patients. Ann Surg. 2006;243:693–698. CrossRef
- Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–3634.
- Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. 1992;8:400–14. CrossRef
- 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.
- Thomas JM, Patocskai EJ. The argument against sentinel node biopsy for malignant melanoma. BMJ. 2000;321:3–4. CrossRef
- Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23. CrossRef
- Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242:302–11.
- Gershenwald JE, Colome MI, Lee JE, 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;16:2253–60.
- Leong SP, Kashani-Sabet M, Desmond RA, et al. Clinical significance of occult metastatic melanoma in sentinel lymph nodes and other high-risk factors based on long-term follow-up. World J Surg. 2005;29:683–691. CrossRef
- Cochran AJ, Morton DL. Detection of clinically relevant melanoma metastases requires focused, not exhaustive, evaluation of sentinel lymph nodes. Am J Surg Pathol. 2006;30:419–20.
- McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–7. CrossRef
- McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer–not yet the standard of care. N Engl J Med. 1998;339:990–5. CrossRef
- Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg. 2000;87:484–489. CrossRef
- Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71. CrossRef
- Carlson GW, Page AJ, Cohen C, et al. Regional recurrence after negative sentinel lymph node biopsy for melanoma. Ann Surg. 2008;248:378–386.
- Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17. CrossRef
- 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. CrossRef
- Yee VS, Thompson JF, McKinnon JG, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol. 2005;12:429–39. CrossRef
- 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. CrossRef
- Conway WC, Faries MB, Nicholl MB, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16:1548–52. CrossRef
- Karim RZ, Scolyer RA, Li W, et al. False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology. Ann Surg. 2008;247:1003–10. CrossRef
- Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.
- Riber-Hansen R, Sjoegren P, Hamilton-Dutoit SJ, et al. Extensive pathological analysis of selected melanoma sentinel lymph nodes: high metastasis detection rates at reduced workload. Ann Surg Oncol. 2008;15:1492–501. CrossRef
- Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4. CrossRef
- Kretschmer L, Beckmann I, Thoms KM, et al. Factors predicting the risk of in-transit recurrence after sentinel lymphonodectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol. 2006;13:1105–12. CrossRef
- Kang JC, Wanek LA, Essner R, et al. Sentinel lymphadenectomy does not increase the incidence of in-transit metastases in primary melanoma. J Clin Oncol. 2005;23:4764–70. CrossRef
- Kretschmer L, Beckmann I, Thoms KM, et al. Sentinel lymphonodectomy does not increase the risk of loco-regional cutaneous metastases of malignant melanomas. Eur J Cancer. 2005;41:531–8. CrossRef
- Nowecki ZI, Rutkowski P, Nasierowska-Guttmejer A, et al. Survival analysis and clinicopathological factors associated with false-negative sentinel lymph node biopsy findings in patients with cutaneous melanoma. Ann Surg Oncol. 2006;13:1655–63. CrossRef
- Caraco C, Marone U, Celentano E, et al. Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14:2662–7. CrossRef
- Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients
Annals of Surgical Oncology
Volume 17, Issue 3 , pp 709-717
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Charles R. Scoggins MD, MBA (1)
- Robert C. G. Martin MD, PhD (1)
- Merrick I. Ross MD (2)
- Michael J. Edwards MD (3)
- Douglas S. Reintgen MD (4)
- Marshall M. Urist MD (5)
- Jeffrey E. Gershenwald MD (2)
- Jeffrey J. Sussman MD (3)
- R. Dirk Noyes MD (6)
- James S. Goydos MD (7)
- Peter D. Beitsch MD (8)
- Stephan Ariyan MD (9)
- Arnold J. Stromberg PhD (10)
- Lee J. Hagendoorn MBA (11)
- Kelly M. McMasters MD, PhD (1)
- Author Affiliations
- 1. Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
- 2. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
- 3. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
- 4. Lakeland Regional Cancer Center, Lakeland, FL, USA
- 5. Department of Surgery, University of Alabama, Birmingham, AL, USA
- 6. LDS Hospital, Salt Lake City, UT, USA
- 7. Cancer Institute of New Jersey, New Brunswick, NJ, USA
- 8. Dallas Surgical Group, Dallas, TX, USA
- 9. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- 10. Department of Statistics, University of Kentucky, Lexington, KY, USA
- 11. Advertek, Inc., Louisville, KY, USA