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Yield and Predictors of Radiologic Studies for Identifying Distant Metastases in Melanoma Patients with a Positive Sentinel Lymph Node Biopsy

  • Melanoma
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Abstract

Background

It is common to obtain radiological studies around the time of a positive sentinel lymph node biopsy (SLNB) to exclude patients with distant metastases from completion lymph node dissection. The yield of such a work-up is unknown.

Methods

Patients were identified from a prospectively maintained database. Medical records were reviewed.

Results

Over an 8-year period, 181 patients had a positive SLNB. At least one study (computed tomography or magnetic resonance imaging of the brain; chest x-ray; computed tomography of the thorax, abdomen, or pelvis; positron-emission tomography scan; or bone scan) was obtained around the time of SLNB in 178 patients (98%). Studies were obtained after SLNB in 107 patients (59%). Studies ordered after SLNB resulted in indeterminate findings in 51 patients (48% of those studied). Among patients tested after SLNB, four were found to have metastatic disease (positive rate 3.7%). All of these patients had both a thick melanoma and macrometastasis within the SLN. The number of patients with indeterminate findings would be decreased and the yield of the work-up increased by 4 fold, by restricting the work-up to those with thick melanoma and macrometastasis.

Conclusions

Radiological studies obtained after a positive SLN produce indeterminate findings in about half of the patients and identify distant disease in 3.7%. Restricting work-up to patients with thick melanoma and macrometastasis on SLNB would spare patients from indeterminate findings and increase the yield of the evaluation.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA

    Jason S. Gold, David P. Jaques, Mary S. Brady & Daniel G. Coit

  2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA

    Klaus J. Busam

Authors
  1. Jason S. Gold
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  2. David P. Jaques
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  3. Klaus J. Busam
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  4. Mary S. Brady
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  5. Daniel G. Coit
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Corresponding author

Correspondence to Daniel G. Coit.

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Gold, J.S., Jaques, D.P., Busam, K.J. et al. Yield and Predictors of Radiologic Studies for Identifying Distant Metastases in Melanoma Patients with a Positive Sentinel Lymph Node Biopsy. Ann Surg Oncol 14, 2133–2140 (2007). https://doi.org/10.1245/s10434-007-9399-3

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  • DOI: https://doi.org/10.1245/s10434-007-9399-3

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