Annals of Oncology Advance Access originally published online on September 12, 2006
Annals of Oncology 2006 17(10):1578-1585; doi:10.1093/annonc/mdl176
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2006 European Society for Medical Oncology
sarcomas and melanoma |
Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?
1 Department of Surgical Oncology, Erasmus University Medical Center–Daniel den Hoed Cancer Center
2 Department of Statistics, Erasmus University Medical Center–Daniel den Hoed Cancer Center
3 Department of Pathology, Erasmus University Medical Center–Daniel den Hoed Cancer Center, The Netherlands
* Correspondence to: Prof A. M. M. Eggermont, Department of Surgical Oncology, Erasmus University Medical Center–Daniel den Hoed Cancer Center, 301 Groene Hilledijk, 3075 EA, Rotterdam, the Netherlands. Tel: +31-10-4391851; Fax: +31-10-4391011; E-mail: a.m.m.eggermont{at}erasmusmc.nl
As only about 20% of sentinel node (SN) positive melanoma patients have additional non-SN lymph node involvement in the Completion Lymph Node Dissection (CLND) specimen, we tried to identify a SN positive patient group, which can be spared CLND. Micro anatomic analyses of metastatic SNs were performed to identify patient/tumor and/or SN factors predicting additional non-SN positivity as well as disease-free and overall survival. SN positivity was found in 77 of 262 stage I/II patients, included into a prospective database (10/97–5/04). Of 74 patients pathology material was available for re-evaluation. Micro anatomic analyses categorized topography of SN-metastases, Starz classification and amount of SN tumor burden. Additional non-SN positivity, DFS, OS and was calculated for all analyses. Mean Breslow thickness was 3.5 mm (0.8–12.0); mean FU was 35 (6–81) months. There was no additional non-SN positivity for SN-micrometastases <0.1 mm. Topography of SN involvement had no impact on OS. Estimated 5-year OS rates for the different groups of <0.1 mm, 0.1–1.0 mm and >1.0 mm SN tumor burden were 100%, 63% and 35% respectively. Distant metastases were exceedingly rare (1/16 = 6.3%) in <0.1 mm SN-positive patients. On multivariate analysis the SN tumor burden was the most important prognostic factor for DFS (P = 0.005) and OS (P = 0.03). Distant metastasis-free survival was identical (91%) to the 5-yr OS of SN negative patients, the estimated 5-yr OS was 100% for these patients and additional non-SN positivity was not observed. Therefore, our data suggest that patients with sub-micrometastases (<0.1 mm) in the SN may be judged as SN negative, as non-stage III, and are highly unlikely to benefit from CLND, which we no longer recommend.
Key words: sentinel node, melanoma, pathology, micro anatomic, prognosis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Z. I. Nowecki, P. Rutkowski, and W. Michej The Survival Benefit to Patients with Positive Sentinel Node Melanoma After Completion Lymph Node Dissection May Be Limited to the Subgroup with a Primary Lesion Breslow Thickness Greater Than 1.0 and Less Than or Equal to 4 mm (pT2-pT3) Ann. Surg. Oncol., August 1, 2008; 15(8): 2223 - 2234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M G Cook and S Di Palma Pathology of sentinel lymph nodes for melanoma J. Clin. Pathol., August 1, 2008; 61(8): 897 - 902. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Satzger, B. Volker, A. Meier, A. Kapp, and R. Gutzmer Criteria in Sentinel Lymph Nodes of Melanoma Patients that Predict Involvement of Nonsentinel Lymph Nodes Ann. Surg. Oncol., June 1, 2008; 15(6): 1723 - 1732. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. J. van Akkooi, J. H. W. de Wilt, C. Verhoef, and A. M. M. Eggermont Cutaneous Melanoma and Sentinel Lymph Node Biopsy Ann. Surg. Oncol., June 1, 2008; 15(6): 1808 - 1809. [Full Text] [PDF]
|
|
|
|
|
|
I. Koskivuo, L. Talve, P. Vihinen, M. Maki, T. Vahlberg, and E. Suominen Author Reply: Sentinel Lymph Node Biopsy in Cutaneous Melanoma Ann. Surg. Oncol., June 1, 2008; 15(6): 1810 - 1811. [Full Text] [PDF]
|
|
|
|
|
|
R. Riber-Hansen, P. Sjoegren, S. J. Hamilton-Dutoit, and T. Steiniche Extensive Pathological Analysis of Selected Melanoma Sentinel Lymph Nodes: High Metastasis Detection Rates at Reduced Workload Ann. Surg. Oncol., May 1, 2008; 15(5): 1492 - 1501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. J. van Akkooi, J. H. W. de Wilt, C. Verhoef, and A. M. M. Eggermont Isolated Tumor Cells and Long-Term Prognosis of Patients with Melanoma Ann. Surg. Oncol., May 1, 2008; 15(5): 1547 - 1548. [Full Text] [PDF]
|
|
|
|
|
|
C. R. Rossi, G. L. De Salvo, E. Bonandini, S. Mocellin, M. Foletto, S. Pasquali, P. Pilati, M. Lise, D. Nitti, E. Rizzo, et al. Factors Predictive of Nonsentinel Lymph Node Involvement and Clinical Outcome in Melanoma Patients With Metastatic Sentinel Lymph Node Ann. Surg. Oncol., May 1, 2008; 15(5): 1552 - 1552. [Full Text] [PDF]
|
|
|
|
 |
|
 J M. Thomas Sentinel lymph node biopsy in malignant melanoma BMJ, April 26, 2008; 336(7650): 902 - 903. [Full Text] [PDF]
|
|
|
|
|
|
C. R. Rossi, G. L. De Salvo, E. Bonandini, S. Mocellin, M. Foletto, S. Pasquali, P. Pilati, M. Lise, D. Nitti, E. Rizzo, et al. Factors Predictive of Nonsentinel Lymph Node Involvement and Clinical Outcome in Melanoma Patients With Metastatic Sentinel Lymph Node Ann. Surg. Oncol., April 1, 2008; 15(4): 1202 - 1210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Scheri, R. Essner, R. R. Turner, X. Ye, and D. L. Morton Isolated Tumor Cells in the Sentinel Node Affect Long-Term Prognosis of Patients with Melanoma Ann. Surg. Oncol., October 1, 2007; 14(10): 2861 - 2866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Scolyer, R Murali, J. Gershenwald, A. Cochran, and J. Thompson Clinical relevance of melanoma micrometastases in sentinel nodes: too early to tell Ann. Onc., April 1, 2007; 18(4): 806 - 808. [Full Text] [PDF]
|
|