Abstract
Background: In most major melanoma treatment centers, sentinel node biopsy (SNB), with complete regional lymph node dissection when a positive sentinel node is found, has now replaced elective lymph node dissection (ELND) for patients with primary cutaneous melanomas who are considered to be at moderate to high risk of nodal recurrence. As for ELND, however, no overall survival benefit for the SNB procedure has yet been demonstrated. The objective of this study was to compare the nodal staging accuracy and duration of survival for SNB and ELND.
Methods: A retrospective cohort study was conducted among patients with American Joint Committee on Cancer (AJCC) stage II disease treated at a single center between 1983 and 2000 with either SNB (n = 672) or ELND (n = 793). Multivariate analyses were performed using the logistic regression model for nodal staging accuracy and Cox’s proportional hazards regression model for survival.
Results: Patient factors that influenced nodal positivity included age, Breslow thickness, ulceration, head or neck primary, and operation type (SNB or ELND). SNB was superior to ELND in the detection of micrometastases (odds ratio 1.23, 95% CI, 1.06 – 1.43) but operation type did not influence survival (P = .24).
Conclusions: Sentinel node biopsy identified more nodal micrometastases than ELND but did not influence survival, although complete regional node dissection was performed in all patients who were SNB positive. This increase in staging accuracy likely results from the reliable identification of the appropriate lymph node field by preoperative lymphoscintigraphy, along with more detailed pathologic examination of the nodes removed by SNB.
Similar content being viewed by others
REFERENCES
Veronesi U, Adamus 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.
Sim FH, Taylor WF, Pritchard DJ, Soule EH. Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomised study. Mayo Clin Proc 1986;61:697–705.
Balch CM, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996;224:255–66.
Uren RF, Howman-Giles RB, Shaw HM, Thompson JF, McCarthy WH. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med 1993;34:1435–40.
Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Ann Surg 1999;230:453–63.
McMasters KM. The Sunbelt Melanoma Trial. Ann Surg Oncol. 2001;8(Suppl):S41–3.
Morton DL, Wen D-R, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9.
Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience. Ann Surg Oncol 2000;7:469–74.
de Wilt JHW, Thompson JF, Uren RF, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg (in press).
Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995;222:394–9.
Essner R, Conforti A, Kelley MC, et al. Efficiency of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999;6:442–9.
Thompson JF, McCarthy WH, Bosch CM, 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.
Ollila DW, McCarthy WH, Felger EA. Therapeutic axillary lymph node dissection for metastatic melanoma. In: Thompson JF, Morton DL, Kroon BBR, eds. Textbook of Melanoma, London: Martin Dunitz, 2004;273–84
Karakousis C, Thompson JF. Groin and pelvic dissection. In: Thompson JF, Morton DL, Kroon BBR, eds. Textbook of Melanoma. London: Martin Dunitz, 2004;285–95
O’Brien CJ, Shah JP, Balm A. Neck dissection and parotidectomy. In: Thompson JF, Morton DL, Kroon BBR, eds. Textbook of Melanoma London: Martin Dunitz, 2004;296–306
Thompson JF, Uren RF. What is a ’sentinel’ lymph node?. Eur J Surg Oncol 2000;26:103–4.
Collet D. Some non-parametric procedures. In: Modelling Survival Data in Medical Research London: Chapman and Hall, 1994;15–51
Cox DR. Regression model and life tables. J R Stat Soc Ser B 1972;34:187–220.
Vollmer RT. Multivariate statistical analysis for pathologists. Part 1: The logistic model. Am J Clin Path 1996;105:115–26.
Meier F, Will S, Ellwanger U, et al. Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Derm 2002;147:62–70.
Gershenwald JE, Thompson W, Mansfield PJ, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–83.
Vuylsteke RJ, van Leeuwen PA, Muller MG, Gietema HA, Kragt DR, Meijer S. Clinical outcome of stage I/II melanoma patients after selective sentinel lymph node dissection: long-term follow-up results. J Clin Oncol 2003;21:1057–65.
Li LL, Scolyer RA, Ka VSK, et al. Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence. Am J Surg Pathol 2003;27:1197–1201.
McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery 2001;130:151–6.
Mraz-Gernhard S, Sagebiel RW, Kashani-Sabet M, JR Miller III, Leong SPL. Prediction of sentinel lymph node micrometastasis by histological features in primary cutaneous malignant melanoma. Arch Dermatol 1998;134:983–7.
Wagner JD, Gordon MS, Chuang T-Y, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer 2000;89:453–62.
Vollmer RT, Seigler HF. A model for pretest probability of lymph node metastasis from cutaneous melanoma. Am J Clin Pathol 2000;114:875–9.
Chao C, RCG Martin II, Ross MI, et al. Correlation between prognostic factors and increasing age. Ann Surg Oncol 2004;11:259–64.
Rousseau DL, Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol 2003;10:569–74.
Sondak VK, Taylor JMG, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol 2004;11:247–58.
Thompson JF, Shaw HM. Should mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy?. Ann Surg Oncol 2004;11:233–5.
Stadelmann WK, Rapaport DP, Soong S-J, Reintgen DS, Buzaid AC, Balch CM. Prognostic clinical and pathologic features. Balch CM Houghton AN Sober AJ S-J Soong eds. Cutaneous Melanoma. 3rd ed. St Louis: Quality Medical Publishing, Inc, 1998:11–35
Carlson GW. Age and the incidence of sentinel lymph node metastases in melanoma. Ann Surg Oncol 2004;11:236–7.
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented to the Society of Surgical Oncology, New York, March 2004
Rights and permissions
About this article
Cite this article
Doubrovsky, A., de Wilt, J.H.W., Scolyer, R.A. et al. Sentinel Node Biopsy Provides More Accurate Staging Than Elective Lymph Node Dissection in Patients With Cutaneous Melanoma. Ann Surg Oncol 11, 829–836 (2004). https://doi.org/10.1245/ASO.2004.01.026
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2004.01.026