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.
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.
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Madrona, A.P., Martínez-Escribano, J., Martínez-Barba, E. et al. Are there factors that predict the result of selective sentinel lymph-node biopsy in melanoma?. Rev Oncol 6, 283–288 (2004). https://doi.org/10.1007/BF02711835
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DOI: https://doi.org/10.1007/BF02711835