Abstract
Background
Sentinel lymph node biopsy (SLNB) is a standard method for determining the pathologic status of the regional lymph nodes.
Aims
The aim of our study was to determine the incidence and clinicopathologic factors predictive of SLN positivity, and to evaluate the prognostic importance of SLNB in patients with cutaneous melanoma.
Methods
We performed a retrospective analysis of a prospectively maintained database of all patients who underwent SLNB for primary melanoma at our institution from 2005 to 2012. Statistical analysis was performed using χ 2 and Fischer exact test.
Results
In total, 318 patients underwent SLNB, of which 65 were for thin melanoma (≤1 mm). There were 36 positive SLNB, 278 negative SLNB and in four cases the SLN was not located. The incidence rate for SLNB was 11.3% overall and 1.5% in thin melanomas alone. Statistical analysis identified Breslow thickness >1 mm (P = 0.006), Clark level ≥ IV (P = 0.004) and age <75 years (P = 0.035) as the strongest predictors of SLN positivity. Our overall false negativity rate was 20% (9/45) with one case of false-negative SLNB in thin melanomas.
Conclusion
Breslow thickness of the primary tumour remains the strongest predictor of SLN positivity. Our findings point to a possible limited role for SLNB in thin melanoma due to its low positivity rate, associated false-negative rate and related morbidity.
Similar content being viewed by others
References
Morton DL, Wen D-R, Wong JH, Economou JS, Cagle LA, Storm FK et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg (Chicago, Ill: 1960) 127(4):392
Wagner JD, Ranieri J, Evdokimow DZ, Logan T, Chuang T-Y, Johnson CS et al (2003) Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg 112(2):486–497
Schmid-Wendtner M-H, Baumert J, Schmidt M, Plewig G, Volkenandt M, Hölzel D (2001) Prognostic index for cutaneous melanoma: an analysis after follow-up of 2715 patients. Melanoma Res 11(6):619–626
Garbe C, Leiter U (2009) Melanoma epidemiology and trends. Clin Dermatol 27(1):3–9
Jacobs IA, DasGupta TK, Salti GI (2003) Role of sentinel lymph node biopsy in patients with thin (<1 mm) primary melanoma. Ann Surg Oncol 10(5):558–561
Balch CM, Gershenwald JE, S-j Soong, Thompson JF, Atkins MB, Byrd DR et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27(36):6199–6206
Kesmodel SB, Karakousis GC, Botbyl JD, Canter RJ, Lewis RT, Wahl PM et al (2005) Mitotic rate as a predictor of sentinel lymph no depositivity in patients with thin melanomas. Ann Surg Oncol 12(6):449–458
Warycha MA, Zakrzewski J, Ni Q, Shapiro RL, Berman RS, Pavlick AC et al (2009) Meta-analysis of sentinel lymph node positivity in thin melanoma (≤1 mm). Cancer 115(4):869–879
Ranieri JM, Wagner JD, Rowlinson SW, Johnson CS, Coleman III JJ (2006) The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol 13(7):927–932
Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI et al (2003) Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 10(6):676–680
Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH (2011) Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol 29(11):1479–1487
Meier F, Will S, Ellwanger U, Schlagenhauff B, Schittek B, Rassner G et al (2002) Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 147(1):62–70
Cascinelli N, Belli F, Santinami M, Fait V, Testori A, Cavaliere R et al (2000) Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience. Ann Surg Oncol 7(6):469–474
Gimotty PA, Guerry D, Ming ME, Elenitsas R, Xu X, Czerniecki B et al (2004) Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer staging. J Clin Oncol 22(18):3668–3676
Yonick DV, Ballo RM, Kahn E, Dahiya M, Yao K, Godellas C et al (2011) Predictors of positive sentinel lymph node in thin melanoma. Am J Surg 201(3):324–328
Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF et al (2014) Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 370(7):599–609
Leijte JA, van der Ploeg IM, Olmos RAV, Nieweg OE, Horenblas S (2009) Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med 50(3):364–367
Han D, Zhao X, Marzban SS, Messina JL, Gonzalez RJ, Sarnaik AA et al (2012) Sentinel node biopsy is indicated for thin melanomas ≥0.76 mm. Ann Surg Oncol 19(11):3335–3342
Wright BE, Scheri RP, Ye X, Faries MB, Turner RR, Essner R et al (2008) Importance of sentinel lymph node biopsy in patients with thin melanoma. Arch Surg 143(9):892
Thompson JF, Soong S-J, Balch CM, Gershenwald JE, Ding S, Coit DG et al (2011) Prognostic significance of mitotic rate in localized primary cutaneous melanoma: an analysis of patients in the multi-institutional American Joint Committee on Cancer melanoma staging database. J Clin Oncol 29(16):2199–2205
Murali R, Hughes MT, Fitzgerald P, Thompson JF, Scolyer RA (2009) Interobserver variation in the histopathologic reporting of key prognostic parameters, particularly Clark level, affects pathologic staging of primary cutaneous melanoma. Ann Surg 249(4):641–647
Ribero S, Osella-Abate S, Sanlorenzo M, Savoia P, Astrua C, Cavaliere G et al (2013) Favourable prognostic role of regression of primary melanoma in AJCC stage I–II patients. Br J Dermatol 169(6):1240–1245
Glud M, Manfé V, Biskup E, Holst L, Dirksen AMA, Hastrup N et al (2011) MicroRNA miR-125b induces senescence in human melanoma cells. Melanoma Res 21(3):253
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
None declared.
Conflict of interest
None declared.
Ethical approval
Not required.
Rights and permissions
About this article
Cite this article
Joyce, K.M., McInerney, N.M., Piggott, R.P. et al. Analysis of sentinel node positivity in primary cutaneous melanoma: an 8-year single institution experience. Ir J Med Sci 186, 847–853 (2017). https://doi.org/10.1007/s11845-017-1559-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-017-1559-2