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Discordance in Histopathologic Evaluation of Melanoma Sentinel Lymph Node Biopsy with Clinical Follow-Up: Results from a Prospectively Collected Database

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node (SLN) status currently represents the single most important prognostic factor in clinically localized melanoma and is widely used in patients with melanoma at significant risk for nodal micrometastasis. Although several studies have looked at the rates and implications of inaccuracies in the histopathologic diagnosis of melanocytic lesions, accuracy in the histologic interpretation of the SLN in melanoma has not been addressed. The goal of this study was to determine the rates of discordance in the histopathologic evaluation of the SLN and the potential clinical impact on patients referred to a comprehensive melanoma center.

Methods

A prospectively collected database was queried for melanoma patients who had SLN biopsies performed at outside institutions before referral to the University of Michigan Multidisciplinary Melanoma Program between 2006 and 2009. These cases were reviewed and clinical follow-up obtained.

Results

After internal review of the SLN material, 13 (8 %) of 167 cases had major discrepancies in diagnosis that impacted patient management and prognosis. The disease of five patients was subsequently downstaged and the disease of eight patients was upstaged after internal review of the SLNs and reversal in diagnoses.

Conclusions

There appears to be a small yet significant rate of discordance in diagnosis of the SLN for melanoma after expert histopathologic review. The implications of this discordance and revision of diagnosis is substantial. Expert histopathologic review of the SLN warrants consideration to provide the most accurate prognostic information and optimal patient care.

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Acknowledgment

We thank Nisha Meireles, Clinical Research Specialist, Multidisciplinary Melanoma Program, for database and data management.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Tufts University School of Medicine, Boston, MA, USA

    Monisha Dandekar MD

  2. Department of Pathology, Medical School and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Lori Lowe MD, Douglas R. Fullen MD & Rajiv M. Patel MD

  3. Department of Dermatology, Medical School and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Lori Lowe MD, Douglas R. Fullen MD, Timothy M. Johnson MD & Rajiv M. Patel MD

  4. Department of Otolaryngology, Medical School and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Timothy M. Johnson MD

  5. Department of Surgery, Medical School and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Timothy M. Johnson MD, Michael S. Sabel MD & Sandra L. Wong MD

Authors
  1. Monisha Dandekar MD
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  2. Lori Lowe MD
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  3. Douglas R. Fullen MD
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  4. Timothy M. Johnson MD
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  5. Michael S. Sabel MD
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  6. Sandra L. Wong MD
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  7. Rajiv M. Patel MD
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Corresponding author

Correspondence to Rajiv M. Patel MD.

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Dandekar, M., Lowe, L., Fullen, D.R. et al. Discordance in Histopathologic Evaluation of Melanoma Sentinel Lymph Node Biopsy with Clinical Follow-Up: Results from a Prospectively Collected Database . Ann Surg Oncol 21, 3406–3411 (2014). https://doi.org/10.1245/s10434-014-3773-8

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  • DOI: https://doi.org/10.1245/s10434-014-3773-8

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