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Cecchi R, De Gaudio C, Buralli L, Innocenti S. Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Management of Primary Cutaneous Melanoma: Report of a Single-centre Experience. TUMORI JOURNAL 2019; 92:113-7. [PMID: 16724689 DOI: 10.1177/030089160609200205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims and Background Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use. Patients and Methods A total of 111 patients with stage I-II AJCC primary cutaneous melanoma underwent lymphatic mapping and sentinel lymph node biopsy from December 1999 through December 2004 using a standardized technique of preoperative lymphoscintigraphy and biopsy guided by blue dye injection in addition to a hand-held gamma probe. After removal, sentinel lymph nodes were submitted to serial sectioning and permanent preparations for histological and immunohistochemical examination. Complete lymph node dissection was performed only in patients with tumor-positive sentinel lymph nodes. Results Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%). The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and > 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%. Conclusions Our study confirms that lymphatic mapping and sentinel lymph node biopsy allow accurate staging and yield relevant prognostic information in patients with early stage melanoma.
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Affiliation(s)
- Roberto Cecchi
- Cutaneous Surgery Service, Pistoia Hospital, Pistoia, Italy.
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Youn GJ, Chung WC. [Micrometastasis in Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 69:270-277. [PMID: 28539031 DOI: 10.4166/kjg.2017.69.5.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the incidence and mortality rate of gastric cancer have been steadily declining, gastric cancer is still the fourth most common cancer in the world and more than 50% of cases occur in Eastern Asia. In Korea, gastric cancer is the second most common cancer and third cause of cancer related death. The standard surgical procedure for resectable advanced gastric cancer is D2 lymphadenectomy with radical gastrectomy. Even though R0 resection was completed, recurrence is relatively common, and contributes to the limited survival of the patients in gastric cancer. As a clinically relevant factor for detection of the recurrence, the presence of isolating tumor cells has been introduced and it is so called as 'micrometastasis'. Numerous immunohistochemistry and molecular studies have shown that micrometastasis can be demonstrated not only in lymph nodes but also in such body compartments as the bone marrow, peritoneal cavity and blood. Herein, we review the current knowledge and evidence of the prognostic significance of micrometastasis in peritoneal, lymph node, bone marrow. Also, we discuss the current state of research on the circulating tumor cell in peripheral blood.
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Affiliation(s)
- Gun Jung Youn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Chul Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Conti A, Santoni M, Burattini L, Scarpelli M, Mazzucchelli R, Galosi AB, Cheng L, Lopez-Beltran A, Briganti A, Montorsi F, Montironi R. Update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients. World J Urol 2015; 35:517-526. [PMID: 26694187 DOI: 10.1007/s00345-015-1752-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Metastases to lymph nodes (LNs) represent an unfavorable prognostic factor in patients with prostate cancer (PCa). Histological examination represents the gold standard in the evaluation of the lymphadenectomy (LND) specimens for the presence of secondary deposits. METHODS AND RESULTS The metastatic detection rate can vary according to the approach adopted in the microscopic analysis of the LNs, which includes frozen-section examination, total inclusion of the tissue with and without whole-mount sections, serial sectioning, and the application of immunohistochemistry. The assessment of the sentinel LN, the search for micrometastases, and the evaluation of atypical LN metastatic sites further contribute to the detection of the metastatic spread. CONCLUSION In this review, an update on the histopathological evaluation of LND specimens in patients with PCa is given, and focus is made on their clinical and prognostic significance.
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Affiliation(s)
- Alessandro Conti
- Department of Odontostomatologic and Specialized Clinical Sciences, Section of Urology, Marche Polytechnic University, School of Medicine, via Conca 71, 60126, Ancona, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, via Conca 71, 60126, Ancona, Italy
| | - Luciano Burattini
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, via Conca 71, 60126, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy
| | - Andrea B Galosi
- Department of Odontostomatologic and Specialized Clinical Sciences, Section of Urology, Marche Polytechnic University, School of Medicine, via Conca 71, 60126, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy.
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Jeuck TLA, Wittekind C. Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases. Gastric Cancer 2015; 18:100-8. [PMID: 24550066 DOI: 10.1007/s10120-014-0352-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. METHODS Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). RESULTS Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. CONCLUSION Immunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.
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Affiliation(s)
- Theresa L A Jeuck
- Institute of Pathology, University Hospital Leipzig, Liebigstrasse 24, 04103, Leipzig, Germany,
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Griniatsos J, Michail O, Dimitriou N, Karavokyros I. Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance. World J Gastrointest Oncol 2012; 4:16-21. [PMID: 22403737 PMCID: PMC3296804 DOI: 10.4251/wjgo.v4.i2.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/03/2011] [Accepted: 10/12/2011] [Indexed: 02/05/2023] Open
Abstract
The 7th TNM classification clearly states that micrometastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage IV. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients.
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Affiliation(s)
- John Griniatsos
- John Griniatsos, Othon Michail, Nikoletta Dimitriou, Ioannis Karavokyros, 1st Department of Surgery, University of Athens, Medical School, GR 115-27, Athens, Greece
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Miyamoto S, Sperry S, Yamashita T, Reddy NP, O'Malley BW, Li D. Molecular imaging assisted surgery improves survival in a murine head and neck cancer model. Int J Cancer 2011; 131:1235-42. [DOI: 10.1002/ijc.27328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/05/2011] [Indexed: 01/03/2023]
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Increased detection of metastatic melanoma in pediatric sentinel lymph node biopsies using RT-PCR on paraffin-embedded tissue. Appl Immunohistochem Mol Morphol 2010; 18:365-70. [PMID: 20571343 DOI: 10.1097/pai.0b013e3181ce1e61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sentinel lymph node (SLN) biopsy has become integral in the staging of patients with melanoma, and entails detailed histologic examination with immunohistochemistry. Reverse transcriptase-polymerase chain reaction (RT-PCR) for tyrosinase transcripts has been used to increase sensitivity but requires a dedicated piece of tissue that does not undergo histologic examination. We developed a nested RT-PCR assay for tyrosinase applicable on paraffin-embedded tissue and applied this to a series of SLNs from pediatric patients with melanoma. Thirty-six SLNs from 4 females and 4 males were included in the study. Eight lymph nodes with reactive changes were included as controls. SLNs were examined histologically and immunohistochemically for S100, tyrosinase, and MART1. Seven patients had between 1 and 4 morphologically-positive SLNs and one patient had negative SLNs (HISTO+; 12/36, 33%). Three lymph nodes were excluded from molecular analysis owing to inadequate RNA, and 29 of the remaining 33 nodes were positive (MOL+; 88%). All patients had at least 1 SLN positive by RT-PCR. Twelve were HISTO+/MOL+; 17 were HISTO-/MOL+; and 4 were HISTO-/MOL-. All control lymph nodes were negative for tyrosinase transcripts. The application of RT-PCR for tyrosinase to paraffin-embedded tissue significantly increased the number of positive SLNs and upstaged one patient from negative to positive. The prognostic implications of such findings require further investigation, especially in the pediatric age group. Nonetheless, this technique provides a useful tool to determine the clinical significance of RT-PCR positivity in melanoma SLNs.
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Griniatsos J, Gakiopoulou H, Yiannakopoulou E, Dimitriou N, Douridas G, Nonni A, Liakakos T, Felekouras E. Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer. World J Gastroenterol 2009; 15:5568-72. [PMID: 19938196 PMCID: PMC2785060 DOI: 10.3748/wjg.15.5568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes.
METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level I lymph node stations (n = 4) were excluded from further analysis. The level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study.
RESULTS: Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage IA to IB in one patient and from stage IB to II in three patients.
CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.
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Carlson JA, Ross JS, Slominski AJ. New techniques in dermatopathology that help to diagnose and prognosticate melanoma. Clin Dermatol 2009; 27:75-102. [DOI: 10.1016/j.clindermatol.2008.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Braun-Falco M, Schempp W, Weyers W. Molecular diagnosis in dermatopathology: What makes sense, and what doesn’t. Exp Dermatol 2009; 18:12-23. [DOI: 10.1111/j.1600-0625.2008.00805.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Toubert ME, Just PA, Baillet G, Kerob D, Hindié E, Verola O, Revol M, Servant JM, Basset-Seguin N, Lebbé C, Banti E, Rubello D, Moretti JL. Slow dynamic lymphoscintigraphy is not a reliable predictor of sentinel-node negativity in cutaneous melanoma. Cancer Biother Radiopharm 2008; 23:443-50. [PMID: 18771348 DOI: 10.1089/cbr.2008.0468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We reviewed data from 160 consecutive patients (89 M/71 F; 53.5 [range, 9-88] years) who had under-gone lymphoscintigraphy and sentinel lymph node biopsy (SNB) in our hospital for histologically proven cutaneous malignant melanoma (CMM) (located on the upper limb: 33; lower limb: 57; trunk: 44; and head and neck: 26 patients), with a Breslow index > 1 mm and without clinical or radiologic evidence of metastatic spread. Colloidal (99m)Tc-rhenium sulfide (36-76 MBq) was injected intradermally in the four quadrants around the tumorectomy scar, followed by dynamic acquisition and static imaging. SN(s) were identified in 157 patients (overall identification rate, 98%). Fast (< 20 minutes), intermediate (20-30 minutes), or slow (> 30 minutes) lymphatic drainage was observed, respectively, in 122 (78%), 24 (15%), or 11 (7%) cases. Overall malignancy rate was 15%, respectively found in 19 (16%), 2 (8%), and 2 (18 %) patients with fast, intermediate, or slow drainage. No statistical difference between SN-positivity rates of patients with fast (19/122 = 16%) versus intermediate or slow drainage (4/35 = 11.4%) was observed (p = 0.69). Therefore, lymphoscintigraphic SN appearance time in CMM patients is unable both to predict SN metastasis and spare them from undergoing SN excision.
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False Negative Sentinel Lymph Node Biopsies in Melanoma May Result From Deficiencies in Nuclear Medicine, Surgery, or Pathology. Ann Surg 2008; 247:1003-10. [DOI: 10.1097/sla.0b013e3181724f5e] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Mangas C, Paradelo C, Rex J, Ferrándiz C. The Role of Sentinel Lymph Node Biopsy in the Diagnosis and Prognosis of Malignant Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mocellin S, Hoon DSB, Pilati P, Rossi CR, Nitti D. Sentinel lymph node molecular ultrastaging in patients with melanoma: a systematic review and meta-analysis of prognosis. J Clin Oncol 2007; 25:1588-95. [PMID: 17443001 DOI: 10.1200/jco.2006.09.4573] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Molecular biology-based ultrastaging of cancer is already part of the standard management of patients with hematologic malignancies, whereas the evidence for solid tumors is much more debated. Polymerase chain reaction (PCR) -based detection of melanoma cells in sentinel lymph nodes (SLN) of patients with melanoma represents an appealing prognostic tool. However, no consensus exists on the clinical implementation of this prognostic indicator for the management of these patients. METHODS Twenty-two studies enrolling 4,019 patients who underwent SLN biopsy for clinical stage I to II cutaneous melanoma were reviewed. Correlation of PCR status with TNM stage, disease recurrence rates, and survival was assessed by means of association statistics and formal meta-analysis, respectively. RESULTS PCR status correlated with both TNM stage (stage I to II v III; PCR positivity, 95.1% v 46.6%; P < .0001) and disease recurrence (PCR positive v negative; relapse rate, 16.8% v 8.7%; P < .0001). PCR positivity was also associated with worse overall (hazard ratio [HR], 5.08; 95% CI, 1.83 to 14.08; P = .002) and disease-free (HR, 3.41; 95% CI, 1.86 to 6.24; P < .0001) survival. Statistical heterogeneity was significant, underscoring the variability among overall effect estimates across studies; metaregression and subgroup analysis did not identify clear-cut sources of heterogeneity, although some study design variables were suggested as potential causes. CONCLUSION PCR status of SLN appears to have a clinically valuable prognostic power in patients with melanoma. Although the heterogeneity of the studies so far published warrants caution to avoid overestimating the favorable results of pooled data, our findings strongly support additional investigation in this field.
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Affiliation(s)
- Simone Mocellin
- Surgery Branch, Department of Oncological & Surgical Sciences, University of Padova, Italy.
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Martinez SR, Mori T, Hoon DSB. Molecular upstaging of sentinel lymph nodes in melanoma: where are we now? Surg Oncol Clin N Am 2006; 15:331-40. [PMID: 16632218 DOI: 10.1016/j.soc.2005.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The presence of lymph node metastasis is the best predictor of disease progression and overall survival in patients who have melanoma. Lymphatic mapping and selective lymphadenectomy allows directed pathologic analysis of the node or nodes most likely to have metastatic disease. To diagnose metastatic disease in SLNs reliably requires a coordinated effort by nuclear medicine physicians, surgeons, and pathologists. Errors may occur if quality assurance is not emphasized at any point during the process. This, along with the presence of occult metastatic disease, may lead to disease recurrence and progression, even when SLN histologically are free of disease. Molecular up-staging of occult malignant disease has the potential to provide important information to facilitate the diagnosis, surveillance, and treatment of cancer. The detection of occult tumor cells in SLNs and blood provides a powerful tool for assessing early regional and systemic disease spread in patients who have AJCC stage II and III-not only melanoma but also other solid tumors. The use of varying panels of markers from different laboratories has hampered the interpretation of data and made it difficult to unravel the merits of molecular up staging. Molecular approaches have made a major impact on the field of infectious disease and should one day be of equal usefulness in the diagnosis of cancer.
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Affiliation(s)
- Steve R Martinez
- Department of Molecular Oncology, John Wayne Cancer Institute at St. John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA
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Mangas C, Hilari JM, Paradelo C, Rex J, Fernández-Figueras MT, Fraile M, Alastrue A, Ferrándiz C. Prognostic significance of molecular staging study of sentinel lymph nodes by reverse transcriptase-polymerase chain reaction for tyrosinase in melanoma patients. Ann Surg Oncol 2006; 13:910-8. [PMID: 16788751 DOI: 10.1245/aso.2006.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 02/01/2006] [Indexed: 01/10/2023]
Abstract
BACKGROUND We performed this study to evaluate the clinical effect of microscopic and submicroscopic metastases in sentinel lymph nodes (SLNs) from patients with early-stage melanoma. METHODS Patients with confirmed cutaneous melanoma (American Joint Committee on Cancer stages I and II) underwent standard lymphoscintigraphy and SLN biopsy. Serial sections were divided between routine histopathology with hematoxylin and eosin plus immunohistochemistry for HMB-45 and molecular analysis by nested reverse transcriptase-polymerase chain reaction (RT-PCR) assay for tyrosinase (using beta-actin as a control). RESULTS Of 180 patients analyzed (318 SLNs), 38 (21%) patients had positive SLN(s) by routine hematoxylin and eosin and immunohistochemistry (microscopic disease; group 1), and 142 (79%) had negative histological results. Analysis by RT-PCR detected tyrosinase in at least 1 SLN from 124 (69%) patients. Among patients with histologically negative SLN(s), tyrosinase was detected in 86 (48%) patients (submicroscopic disease; group 2), whereas 40 (22%) patients had negative results by both histology and RT-PCR (group 3). Sixteen (9%) patients had histologically negative SLNs and ambiguous RT-PCR results (group 4). Among 138 patients in the analysis of recurrence (mean follow-up, 45 months), only 18 patients had a recurrence: 11 (31%) of 35 in group 1, 5 (10%) of 51 in group 2, and 2 (5%) of 37 in group 3. No recurrences were seen in group 4. Only group 1 had a significantly shorter disease-free survival and overall survival compared with the other groups. CONCLUSIONS After a long follow-up period, molecular upstaging by tyrosinase RT-PCR failed to detect a subgroup of patients with an increased probability of recurrence.
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Affiliation(s)
- Cristina Mangas
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Carretera Canyet s/n., 08916, Badalona, Spain
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Carlson JA, Ross JS, Slominski A, Linette G, Mysliborski J, Hill J, Mihm M. Molecular diagnostics in melanoma. J Am Acad Dermatol 2006; 52:743-75; quiz 775-8. [PMID: 15858465 DOI: 10.1016/j.jaad.2004.08.034] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Molecular pathology is rapidly evolving, featuring continuous technologic improvements that offer novel clinical opportunities for the recognition of disease predisposition, for identifying sub-clinical disease, for more accurate diagnosis, for selecting efficacious and non-toxic therapy, and for monitoring of disease outcome. Currently, the identification and prognosis of primary cutaneous melanoma is based on histologic factors (tumor depth and ulceration) and clinical factors (number of lymph node and/or distant metastases). However, metastasis can occur in patients with thin melanomas, and sentinel lymph node biopsy does not identify all patients at risk for distant metastasis. New markers exist that correlate with melanoma progression, which may aid in melanoma identification, prognostication, and detection of minimal residual disease/early recurrence. Moreover, not many therapeutic options exist for melanoma as no regimen prolongs survival. Emerging data with investigational therapies suggest that certain markers might play a crucial role in identifying patients who will respond to therapy or show utility in the monitoring the response to therapy. Herein, molecular diagnostics that can potentially benefit the individual melanoma patient will be discussed.
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Affiliation(s)
- J Andrew Carlson
- Division of Dermatopathology, Albany Medical College, Albany, New York 12208, USA.
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Oliveira Filho RSD, Silva AMD, Arcuschin L, Wagner J, Yamaga LY. Recorrência em pacientes portadores de melanoma cutâneo submetidos a biópsia de linfonodo sentinela: seguimento mediano de 37 meses. Rev Col Bras Cir 2004. [DOI: 10.1590/s0100-69912004000500002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: A biópsia de linfonodo sentinela (BLS) representa um avanço na cirurgia oncológica para o microestadiamento do melanoma. Apresentamos nossa experiência dando ênfase para a recorrência. MÉTODO: A BLS foi realizada em 133 pacientes portadores de melanoma cutâneo localizado envolvendo linfocintilografia, mapeamento linfático e detecção gama intra-operatórios em todos os pacientes. O exame histopatológico foi realizado por HE e imunohistoquímica (IHC). RESULTADOS: Encontrou-se LS em 128 pacientes (96,2%). Micrometástase foi diagnosticada em 20 pacientes (15,6%). Houve nove recorrências, sendo quatro no grupo com LS negativo (108 pacientes). Neste grupo, houve uma recorrência sistêmica e três (2,8%) na região linfática de drenagem (falso negativo). No grupo com LS positivo (20 pacientes) ocorreram cinco recorrências. Houve diferença significativa de recorrência entre os grupos, tendo sido menor no grupo LS negativo (p=0,0048). Através de análise de regressão logística univariada a ulceração (p=0,029) e a positividade do LS (p=0,003) apresentaram significância estatística como fatores de risco. Porém, apenas a positividade do LS manteve singificância na análise multivariada (p=0,024). O seguimento mediano foi de 37 meses. CONCLUSÕES: Pacientes com LS positivo apresentam recorrência significativamente maior que pacientes com LS negativo. O índice de falso negativo foi de 2,8% e os pacientes não apresentaram seqüelas o que permite considerar a BLS como procedimento seguro para o microestadiamento do melanoma cutâneo.
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Affiliation(s)
- Timothy M Pawlik
- Department of Surgical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
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Jin HY, Yamashita T, Minamitsuji Y, Omori F, Jimbow K. Detection of tyrosinase and tyrosinase-related protein 1 sequences from peripheral blood of melanoma patients using reverse transcription-polymerase chain reaction. J Dermatol Sci 2003; 33:169-76. [PMID: 14643522 DOI: 10.1016/j.jdermsci.2003.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND malignant melanoma has one of the highest rates of metastasis. Unlike other solid cancers, no sensitive tumor markers or laboratory tests that can provide information of the risk of metastasis and predict the prognosis have yet been established. OBJECTIVE the study was done to establish a RT-PCR sensitive and specific enough to detect melanocyte-specific transcripts from peripheral blood cells. METHODS peripheral white blood cells were collected from 30 healthy donors and 43 melanoma patients. Melanocyte-specific tyrosinase (TYR) and tyrosinase-related protein 1 (TYRP1) were selected as targets of RT-PCR. The sensitivity of detection using SK-mel-23 melanoma cells and rates of false-positiveness using non-melanoma blood were compared between single-step PCR and nested PCR. Analysis of melanoma blood samples was carried out by the single-step PCR. RESULTS the nested RT-PCR amplified the TYR and TYRP1 sequences from 14 and 2 of the 30 healthy bloods, respectively. However, the single-step RT-PCR did not amplify TYR or TYRP1 sequences from any of the healthy controls. Our single-step RT-PCR detected 1.7 and 0.8 SK-mel-23 melanoma cells per ml blood for TYR and TYRP1, respectively. Overall, TYR mRNA was detected in 15 of the 43 melanoma patients (34.9%), and TYRP1 mRNA in 16 of the 43 (37.2%). The specificities of detection of TYR and TYRP1 were 83.3 and 88.9%, respectively. CONCLUSION our single-step RT-PCR for TYR and TYRP1 mRNAs is more specific than the previous nested RT-PCR for TYR and applicable to detect circulating melanoma cells.
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Affiliation(s)
- Hai-Ying Jin
- Department of Dermatology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan
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