Annals of Surgical Oncology

, Volume 14, Issue 7, pp 2133–2140 | Cite as

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

  • Jason S. Gold
  • David P. Jaques
  • Klaus J. Busam
  • Mary S. Brady
  • Daniel G. Coit
Melanoma

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.

Keywords

Melanoma Sentinel lymph node Metastasis Computed tomography Positron-emission tomography Radiology 

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Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Jason S. Gold
    • 1
  • David P. Jaques
    • 1
  • Klaus J. Busam
    • 2
  • Mary S. Brady
    • 1
  • Daniel G. Coit
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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