Advertisement

Revista de Oncología

, Volume 6, Issue 5, pp 283–288 | Cite as

Are there factors that predict the result of selective sentinel lymph-node biopsy in melanoma?

  • Antonio Piñero MadronaEmail author
  • Jorge Martínez-Escribano
  • Enrique Martínez-Barba
  • Belén Ferri Ñiguez
  • Manuel Canteras Jordana
  • Francisco Nicolás-Ruiz
  • José Manuel Rodríguez González
  • José Frías Iniesta
  • Pascual Parrilla Paricio
Originales

Abstract

Background

Sentinel lymph node biopsy is an appropriate method to assess lymphatic involvement in cutaneous melanoma. We collated clinical and histo-pathological parameters of primary tumours to assess their predictive value of sentinel lymph node involvement.

Patients and methods

Factors such as age, gender, histology subtype, site, Breslow index, lesion size, and the presence of ulceration, signs of regression, lympho-vascular invasion and/or inflammatory infiltration of the primary lesion were collated from 142 patients diagnosed with cutaneous melanoma. During the scheduled surgery, a selective sentinel lymph node biopsy was taken. The procedure was successful in terms of localisation with scintigraphy, detection and surgical removal. Univariate and multivariate statistical analyses were applied to the variables in relation to the sentinel lymph node biopsy results.

Results

There were significant differences with respect to size (p=0.046), the presence of ulceration in the primary lesion (p=0.0146), the Breslow index (p=0.0001) and lympho-vascular invasion in the primary lesion (p=0.00005). Logistic regression showed an independent predictive value for sentinel lymph node involvement.

Conclusions

The data indicate that, apart from Breslow index, the presence of lymphatic invasion in the primary tumour, the size of the melanoma, and the presence of ulceration are independent factors predictive of a positive result of selective sentinel lymph node biopsy in cutaneous melanoma. Although prospective studies are still awaited, these variables need to be taken into account when such biopsies are proposed, even with less thick tumours.

Key words

melanoma sentinel lymph node 

¿Hay factores que predigan el resultado de la biopsia selectiva del ganglio centinela en el melanoma?

Resumen

Introducción

La biopsia selectiva del ganglio centinela en el melanoma cutáneo es un método válido para conocer si existe afectación fática. Pretendemos estudiar la existencia de parámetros clínicos e histopatológicos relacionados con el tumor primario que pudieran ser predictivos de la afectación del ganglio centinela.

Material y métodos

Se estudiaron 142 pacientes intervenidos por melanoma cutáneo a los que se les realizó la biopsia del ganglio centinela habiéndose localizado al menos un ganglio tanto en la gammagrafía como en la cirugía. Se valoraron la edad, sexo, tipo histológico, localización, índice de Breslow, tamaño de la lesión y presencia o no de ulceración, regresión, invasión linfovascular y/o infiltrado inflamatorio en la lesión primaria. Se realizó un análisis univariante y multivariante para estudiar la relación de estos factores con el resultado del ganglio centinela.

Resultados

Se encontraron diferencias significativas para el tamaño (p=0,046), la ulceración en el tumor primario (p=0,0146) y, sobre todo, para el índice de Breslow (p=0,0001) y la invasión linfovascular (p=0,00005). La regresión logística mostró un valor predictivo independiente del estado del ganglio centinela.

Conclusiones

El análisis de los datos de nuestra serie muestra que, además del índice de Breslow, la presencia de invasión linfática en el tumor primario, el tamaño del melanoma y la presencia de ulceración, son factores predictivos independientes para el resultado positivo de la biopsia selectiva del ganglio centinela en el melanoma cutáneo y, por tanto, a falta de estudios prospectivos, estas variables deben tenerse en cuenta a la hora de indicar la realización de dicha biopsia aun con espesores tumorales pequeños.

Palabras clave

melanoma ganglio centinela 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Coit DG, Rogatko A, Brennan MF. Prognostic factors in patients with melanoma metastases to axillary or inguinal lymph nodes: a multivariate analysis. Am Surg 1991;214:627–36.Google Scholar
  2. 2.
    Balch CM, Buzaid AC, Atkins MB, et al. A new American Joint Committee on Cancer staging system for cutaneous melanoma. Cancer 2000;88:1484–91.CrossRefGoogle Scholar
  3. 3.
    Veronesi U, Adams J, Bandiera DC, et al. Inefficacy of immediate node dissection in stage I melanoma of the limbs. N Engl J Med 1977;297:627–30.CrossRefGoogle Scholar
  4. 4.
    Lens MB, Dawes M, Goodacre T, et al. Elective lymph node dissection in patients with melanoma. Systematic review and meta-analysis of randomised controlled trials. Arch Surg 2002;137:458–61.PubMedGoogle Scholar
  5. 5.
    Beaulac SM, McNair LA, Scott TE, et al. Lymphedema and quality of life in survivors of early-stage breast cancer. Arch Surg 2002;137:1253–7.CrossRefGoogle Scholar
  6. 6.
    Thompson JF, McCarthy WH, Bosch CMJ, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res 1995;5:255–60.CrossRefGoogle Scholar
  7. 7.
    Cobben DCP, Koopal S, Tiebosch ATMG, et al. New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma. Eur J Surg Oncol 2002;28:692–700.CrossRefGoogle Scholar
  8. 8.
    Sumner W, Ross M, Lee J, et al. Frequency and significance of lymphatic drainage to unusual sentinel nodal sites in patients with primary cutaneous melanoma. Cancer 2002;95:354–60.CrossRefGoogle Scholar
  9. 9.
    Mansson-Brahme E, Carstensen J, Erhardt K, et al. Prognostic factors in thin cutaneous malignant melanoma. Cancer 1994;73:2324–32.CrossRefGoogle Scholar
  10. 10.
    Balch CM, Soong SJ, Shaw HM, et al. An analysis of prognostic factors in 8.500 patients with cutaneous melanoma. En: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong SJ, editors. Cutaneous melanoma. 2nd ed. Philadelphia: JB Lippincott Co., 1992; p. 165–87.Google Scholar
  11. 11.
    Cochran AJ, Elashoff D, Morton DL, et al. Individualized prognosis for melanoma patients. Hum Pathol 2000;31:327–31.CrossRefGoogle Scholar
  12. 12.
    Salman SM, Rogers GS. Prognostic factors in thin cutaneous melanoma. J Dermatol Surg Oncol 1990;16:413–8.CrossRefGoogle Scholar
  13. 13.
    Breslow A. Thickness, cross-sectioned area and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 1970;172:902–8.CrossRefGoogle Scholar
  14. 14.
    Koh HK. Cutaneous melanoma. N Engl J Med 1991;325:171–82.CrossRefGoogle Scholar
  15. 15.
    Morton DL, Davtyan DG, Waneck LA, et al. Multivariate analysis of the relationship between survival and the microstage of primary melanoma by Clark level and Breslow thickness. Cancer 1993;71:3737–43.CrossRefGoogle Scholar
  16. 16.
    Clark WH, Elder DE, Guerry D, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 1989;81:1893–904.CrossRefGoogle Scholar
  17. 17.
    Friedman RJ, Rigel DS, Kopf AW, et al. Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation. Dermatol Clin 1991; 9:643–8.PubMedGoogle Scholar
  18. 18.
    Dubben HH, Thames HD, Beck-Bornholdt HP. Tumor volume: a basic and specific response predictor in radiotherapy. Radiother Oncol 1998;47:167–74.CrossRefGoogle Scholar
  19. 19.
    Ahmed I. Malignant melanoma: prognostic indicators. Mayo Clin Proc 1997;72:356–61.CrossRefGoogle Scholar
  20. 20.
    Slingluff CL. Lethal “thin” malignant melanoma. Ann Surg 1987;208:150–7.CrossRefGoogle Scholar
  21. 21.
    Gromet MA, Epstein WL, Blois MS. The regressing thin malignant melanoma. Cancer 1978;42:2282–92.CrossRefGoogle Scholar
  22. 22.
    Ronan SG, Eng AM, Briele HA, et al. Thin malignant melanoma with regression and metastases. Arch Dermatol 1987;123:1326–30.CrossRefGoogle Scholar
  23. 23.
    Blessing K, McLaren KM. Histological regression in primary cutaneous melanoma: recognition, prevalence and significance. Histopathology 1992;20:315–22.CrossRefGoogle Scholar
  24. 24.
    Shaw HM, McCarthy SW, McCarthy WH, et al. Thin regressing malignant melanoma: significance of concurrent regional lymph node metastases. Histopathology 1989;15:257–65.CrossRefGoogle Scholar
  25. 25.
    Kelly JW, Sagebiel RW, Blois MS. Regression in malignant melanoma: a histologic feature without independent prognostic significance. Cancer 1985;56:2287–91.CrossRefGoogle Scholar
  26. 26.
    Day CL, Harrist TJ, Lew RA, et al. Classification of malignant melanomas according to the histologic morphology of melanoma nodules. J Dermatol Surg Oncol 1982;8:874–900.CrossRefGoogle Scholar
  27. 27.
    Kopf AW, Welkovich B, Frankel RE, et al. Thickness of malignant melanoma: global analysis of related factors. J Dermatol Surg Oncol 1987;13:345–9.CrossRefGoogle Scholar
  28. 28.
    Clemente CG, Mihm MC, Bufalino R, et al. Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma. Cancer 1996;77:1303–10.CrossRefGoogle Scholar
  29. 29.
    Larsen TE, Grude TH. Relation of cross sectional profile, level of invasion, ulceration and vascular invasion to tumor type and prognosis. Acta Pathol Microbiol Scand 1979;87:242–53.Google Scholar
  30. 30.
    Chen M, Palleschi S, Khoynezhad A, et al. Role of primary breast cancer characteristics in predicting positive sentinel lymph node biopsy results. A multivariate analysis. Arch Surg 2002;137:606–10.CrossRefGoogle Scholar

Copyright information

© FESEO 2004

Authors and Affiliations

  • Antonio Piñero Madrona
    • 1
    Email author
  • Jorge Martínez-Escribano
    • 2
  • Enrique Martínez-Barba
    • 3
  • Belén Ferri Ñiguez
    • 3
  • Manuel Canteras Jordana
    • 4
  • Francisco Nicolás-Ruiz
    • 5
  • José Manuel Rodríguez González
    • 1
  • José Frías Iniesta
    • 2
  • Pascual Parrilla Paricio
    • 1
  1. 1.Department of General SurgeryVirgen de la Arrixaca University HospitalMurciaSpain
  2. 2.Department of DermatologyVirgen de la Arrixaca University HospitalMurciaSpain
  3. 3.Department of PathologyVirgen de la Arrixaca University HospitalMurciaSpain
  4. 4.Department of Statistics. School of MedicineMurcia UniversitySpain
  5. 5.Department of Nuclear MedicineVirgen de la Arrixaca University HospitalMurciaSpain

Personalised recommendations