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Mellemgaard C, Christensen IJ, Salkus G, Wirenfeldt Staun P, Korsgaard N, Hein Lindahl K, Skaarup Larsen M, Klausen S, Lade-Keller J. Reducing workload in malignant melanoma sentinel node examination: a national study of pathology reports from 507 melanoma patients. J Clin Pathol 2024; 77:312-317. [PMID: 36737244 DOI: 10.1136/jcp-2022-208743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
AIMS Even though extensive melanoma sentinel node (SN) pathology protocols increase metastasis detection, there is a need for balancing high detection rates with reasonable workload. A newly tested Danish protocol recommended examining nodes at six levels 150 µm apart (six-level model) and using SOX10 and Melan-A immunohistochemistry (IHC). We explored if a protocol examining 3 levels 300 µm apart (three-level model) combined with IHC would compromise metastasis detection. The study aim was to optimise the protocol to reduce workload without compromising detection rate. METHODS 8 months after protocol implementation, we reviewed the pathology reports of SNs from 507 melanoma patients nationwide, including 117 SN-positive patients. Each report was reviewed to determine histopathological features, including detection of metastasis, exact levels with metastasis, exact levels with metastasis >1 mm in diameter and IHC results. RESULTS The six-level model detected metastases in 23% of patients, whereas the three-level model would have detected metastases in 22% of patients. The three-level model would have missed a few small metastases (n=4), measuring <0.1 mm, 0.1 mm, 0.4 mm and 0.1 mm, respectively. The six-level model detected metastases >1 mm in 7% of patients. One of these metastases (measuring 1.1 mm) would have been detected by the three-level model, but not as >1 mm. SOX10 and Melan-A had equal sensitivity. CONCLUSIONS Reducing the number of levels examined to three levels 300 µm apart combined with IHC does not have significant impact on metastasis detection rate, and we will therefore recommend that the future melanoma SN guideline takes this into consideration to reduce overall workload.
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Affiliation(s)
- Carina Mellemgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - Ib Jarle Christensen
- Department of Pathology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Giedrius Salkus
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Niels Korsgaard
- Department of Pathology, Hospital South West Jutland, Esbjerg, Denmark
| | | | | | - Siri Klausen
- Department of Pathology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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Hartsough EM, Miller D, Shanley R, Domingo-Musibay E, Giubellino A. Sentinel Lymph Node Tumor Burden Using Digital Cell Count Estimation Predicts Outcomes in Melanoma. Histopathology 2021; 80:954-964. [PMID: 34402533 DOI: 10.1111/his.14541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous melanoma often metastasizes in primis to sentinel lymph nodes (SLNs). Currently, there is no standardized method of characterizing micrometastatic tumor burden in SLN biopsies for melanoma. Different criteria have been developed to evaluate SLN biopsies, yet none consider the number of cells identified. AIM Here, we used software analysis to digitally quantify metastatic tumor burden within SLNs and correlated these data with clinicopathologic and prognostic information. METHODS We identified 246 cases of SLN biopsies, including 63 positive (26%) and 183 (74%) negative for metastatic melanoma. Digital cell counting was performed within the greatest metastatic focus and the entire metastatic tumor burden within the same SLN. RESULTS Increasing cell count in the largest metastatic deposit correlated with the previously described Rotterdam (Spearman's r = 0.91; 95% CI: 0.84, 0.94), Starz (Spearman's r = 0.78; 95% CI: 0.68, 0.87), and Dewar criteria (p < 0.01), validating our method of using cell count to define SLN tumor burden. Additionally, increasing cell count was associated with decreased metastasis free survival (HR = 2.29; 95% CI: 1.22, 4.31). CONCLUSION These data support the use of computerized cell count analysis for prognostication of outcomes in patients undergoing SLN biopsy.
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Affiliation(s)
- Emily M Hartsough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Daniel Miller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, 55455, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Ryan Shanley
- Masonic Cancer Center Biostatistics Core, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Evidio Domingo-Musibay
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, 55455, USA
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Fuglsang K, Blaakaer J, Petersen LK, Mejlgaard E, Hammer A, Steiniche T. Detection of high-risk human papillomavirus DNA in tissue from primary cervical cancer tumor, pelvic lymph nodes and recurrent disease. PAPILLOMAVIRUS RESEARCH 2018; 7:15-20. [PMID: 30557633 PMCID: PMC6313832 DOI: 10.1016/j.pvr.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Objectives The present study investigated Human Papillomavirus (HPV) DNA genotyping in primary tumor, pelvic lymph nodes (PLN) and recurrence in early-stage cervical cancer patients. Methods We conducted a hospital-based case-control study. From 2003 to 2015, 282 patients underwent surgery for cervical cancer in the Department of Gynecology, Aarhus University Hospital, Denmark. Twenty-nine recurrent cases were identified. HPV DNA genotyping was performed on formalin-fixed, paraffin-embedded tissue specimens from the primary tumor, PLN, and recurrent disease. Results In the primary tumor, HPV DNA was detectable in 18(72%) of 25 tissue specimens from recurrent cases and in 15(83%) of 18 controls. HPV DNA-positive PLN was significantly associated with recurrence, 83%(95%CI: 52–98%), compared to patients with HPV-negative PLN, 38%(95%CI: 18–62%)(p < 0.05). HPV DNA genotyping was positive in eight of 12(67%) patients with recurrent disease. The genotype was identical in all three tissues types. The positive predictive value for recurrence was the same for detection of HPV-DNA and metastases in the PLN, with reasonable sensitivity. The negative predictive value for recurrence, however, was best for HPV-DNA, 62%(95%CI: 38–98%). Conclusions In conclusion, our data suggest that the presence of HPV in pelvic lymph nodes is associated with an increased risk of recurrence.
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Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Measuring the quality of melanoma surgery - Highlighting issues with standardization and quality assurance of care in surgical oncology. Eur J Surg Oncol 2016; 43:561-571. [PMID: 27422583 DOI: 10.1016/j.ejso.2016.06.397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 06/18/2016] [Indexed: 01/21/2023] Open
Abstract
In an attempt to ensure high standards of cancer care, there is increasing interest in determining and monitoring the quality of interventions in surgical oncology. In recent years, this has been particularly the case for melanoma surgery. The vast majority of patients with melanoma undergo surgery. Usually, this is with combinations of wide excision, sentinel lymph node biopsy and lymphadenectomy. The indications for these procedures evolved during a time when no effective systemic adjuvant therapy was available, and whilst the rationale has been sound, the justification for differences in extent and thoroughness has generally been supported by inadequate or low-level evidence. This has led to a substantial variation among melanoma centres or even among surgeons within a centre in how these procedures are done. With recent rapid progress in the efficacy of systemic treatments that are impacting on overall survival, the prospect of long-term survival in these previously high risk patients means that more than ever long-term locoregional control of melanoma is imperative. Furthermore, the understanding of effects of systemic therapy on locoregional disease will only be interpretable if surgeons use standardized, high quality techniques. This article focuses on standardization and evolution of quality indicators for melanoma surgery and how these might have a positive impact on patient care.
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Denoth S, Broglie MA, Haerle SK, Huber GF, Haile SR, Soltermann A, Jochum W, Stoeckli SJ. Histopathological mapping of metastatic tumor cells in sentinel lymph nodes of oral and oropharyngeal squamous cell carcinomas. Head Neck 2014; 37:1477-82. [DOI: 10.1002/hed.23782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/07/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- Seraina Denoth
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
| | - Stephan K. Haerle
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Zurich; Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Zurich; Switzerland
| | - Sarah R. Haile
- Clinical Trials Unit; Kantonsspital St. Gallen; Switzerland
| | - Alex Soltermann
- Department of Clinical Pathology; University Hospital of Zurich; Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen; Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
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Histopathologic evaluation of the sentinel lymph node for malignant melanoma: the unstandardized process. Am J Dermatopathol 2014; 36:80-7. [PMID: 23860116 DOI: 10.1097/dad.0b013e31829432c7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Metastasis from malignant melanoma (MM) usually first presents in the draining lymph node basin and thus sentinel lymph node (SLN) biopsy is a staging tool used to predict risk of metastases and death in higher risk tumors and has become the standard of care. Differences in the processing and methods used in the histopathological examination of SLNs can affect the positivity rate for metastatic MM because isolated MM deposits may be small and variably distributed in the SLN. The examination of SLNs is not standardized. The authors surveyed institutions across the United States who process SLNs for MM to better characterize the current methods used and to suggest a standardized approach to improve the reliability of the SLN biopsy. A survey of 142 academic institutions in the United States regarding the methods used in the evaluation of the SLN biopsy for MM was conducted. Thirty-two institutions responded. Eighty-one percent of the institutions (26 of 32) had a protocol that they used for SLN examination. In regards to gross dissection, 28% of the responders (9 of 32) initially bivalve (cut the SLN in half), whereas 59% (19 of 32) use a bread loaf technique, cutting the SLN at even intervals without specifically commenting about orientation to the hilum. The number of levels initially cut from the SLN block varied from 1 to 8 levels per block. Thirty-nine percent of the respondents (12 of 31) routinely order immunohistochemistry before evaluation of the initial hematoxylin- and eosin-stained sections. Eighty percent of the respondents (24 of 30) report the maximum dimension of the metastatic tumor deposit. The response rate was low (22%), and most respondents did not indicate how many SLN accessions were performed at their institution each year. Histologic protocols for processing SLNs for MM vary among institutions. Different methods of handling SLNs result in varying sensitivities for detection of metastases. Data derived from these varied approaches to develop and determine prognostic and staging categories may be inconsistent. A standardized yet practical approach is needed to provide reliable information on which prognosis can be determined and therapeutic guidelines can be based. The hope is for dermatologists and those treating patients with MM to understand the intricacies and inconsistencies involved in performance and interpretation of this key staging tool.
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Riber-Hansen R, Hamilton-Dutoit SJ, Steiniche T. Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study. APMIS 2014; 122:968-75. [DOI: 10.1111/apm.12240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Torben Steiniche
- Institute of Pathology; Aarhus University Hospital; Aarhus Denmark
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Ulmer A, Dietz K, Hodak I, Polzer B, Scheitler S, Yildiz M, Czyz Z, Lehnert P, Fehm T, Hafner C, Schanz S, Röcken M, Garbe C, Breuninger H, Fierlbeck G, Klein CA. Quantitative measurement of melanoma spread in sentinel lymph nodes and survival. PLoS Med 2014; 11:e1001604. [PMID: 24558354 PMCID: PMC3928050 DOI: 10.1371/journal.pmed.1001604] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 01/09/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sentinel lymph node spread is a crucial factor in melanoma outcome. We aimed to define the impact of minimal cancer spread and of increasing numbers of disseminated cancer cells on melanoma-specific survival. METHODS AND FINDINGS We analyzed 1,834 sentinel nodes from 1,027 patients with ultrasound node-negative melanoma who underwent sentinel node biopsy between February 8, 2000, and June 19, 2008, by histopathology including immunohistochemistry and quantitative immunocytology. For immunocytology we recorded the number of disseminated cancer cells (DCCs) per million lymph node cells (DCC density [DCCD]) after disaggregation and immunostaining for the melanocytic marker gp100. None of the control lymph nodes from non-melanoma patients (n = 52) harbored gp100-positive cells. We analyzed gp100-positive cells from melanoma patients by comparative genomic hybridization and found, in 45 of 46 patients tested, gp100-positive cells displaying genomic alterations. At a median follow-up of 49 mo (range 3-123 mo), 138 patients (13.4%) had died from melanoma. Increased DCCD was associated with increased risk for death due to melanoma (univariable analysis; p<0.001; hazard ratio 1.81, 95% CI 1.61-2.01, for a 10-fold increase in DCCD + 1). Even patients with a positive DCCD ≤3 had an increased risk of dying from melanoma compared to patients with DCCD = 0 (p = 0.04; hazard ratio 1.63, 95% CI 1.02-2.58). Upon multivariable testing DCCD was a stronger predictor of death than histopathology. The final model included thickness, DCCD, and ulceration (all p<0.001) as the most relevant prognostic factors, was internally validated by bootstrapping, and provided superior survival prediction compared to the current American Joint Committee on Cancer staging categories. CONCLUSIONS Cancer cell dissemination to the sentinel node is a quantitative risk factor for melanoma death. A model based on the combined quantitative effects of DCCD, tumor thickness, and ulceration predicted outcome best, particularly at longer follow-up. If these results are validated in an independent study, establishing quantitative immunocytology in histopathological laboratories may be useful clinically.
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Affiliation(s)
- Anja Ulmer
- Department of Dermatology, University of Tübingen, Tübingen, Germany
- * E-mail: (AU); (CAK)
| | - Klaus Dietz
- Department of Medical Biometry, University of Tübingen, Tübingen, Germany
| | - Isabelle Hodak
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
| | - Bernhard Polzer
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
- Project Group Personalized Tumor Therapy, Fraunhofer-Institut für Toxikologie und Experimentelle Medizin, Regensburg, Germany
| | - Sebastian Scheitler
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
| | - Murat Yildiz
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
| | - Zbigniew Czyz
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
- Project Group Personalized Tumor Therapy, Fraunhofer-Institut für Toxikologie und Experimentelle Medizin, Regensburg, Germany
| | - Petra Lehnert
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Tanja Fehm
- Department of Gynecology, University of Düsseldorf, Düsseldorf, Germany
| | - Christian Hafner
- Department of Dermatology, University of Regensburg, Regensburg, Germany
| | - Stefan Schanz
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Martin Röcken
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Gerhard Fierlbeck
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Christoph A. Klein
- Chair of Experimental Medicine and Therapy Research, Department of Pathology, University of Regensburg, Regensburg, Germany
- Project Group Personalized Tumor Therapy, Fraunhofer-Institut für Toxikologie und Experimentelle Medizin, Regensburg, Germany
- * E-mail: (AU); (CAK)
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Abstract
PURPOSE OF REVIEW Sentinel node biopsy (SNB) for primary melanoma is accepted worldwide as a diagnostic procedure. When sentinel node positive, the invasive completion lymph node dissection (CLND) is usually performed. Approximately 20% of CLND patients have nonsentinel node (NSN) metastases. The therapeutic benefit is unknown. This review analyzed the necessity of CLND in sentinel node positive patients. RECENT FINDINGS Prognosis of sentinel node positive patients is highly heterogeneous. The Rotterdam and Dewar criteria and S-classification are important sentinel node tumor burden criteria to stratify melanoma patients for prognosis and risk of NSN metastases. Patients with less than 0.1 mm metastases seem to have similar prognosis as sentinel node negative patients, especially when located in the subcapsular area. This depends on the use of an extensive sentinel node pathology protocol identifying possibly clinically irrelevant micrometastases. SUMMARY Consensus on the sentinel node pathology work-up and analysis protocols are crucial for correct risk stratification and for clinical decision-making. Primary and sentinel node tumor burden parameters and patient comorbidities should be taken into consideration when offering CLND to an individual patient. In the future, prospective studies such as the MSLT-II and the EORTC 1208 (Minitub) will provide answers to whether CLND has a therapeutic benefit and to which patients might safely be spared CLND.
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Treatment influencing down-staging in EORTC Melanoma Group sentinel node histological protocol compared with complete step-sectioning: A national multicentre study. Eur J Cancer 2012; 48:347-52. [DOI: 10.1016/j.ejca.2011.08.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/16/2011] [Accepted: 08/30/2011] [Indexed: 11/22/2022]
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Murali R, DeSilva C, McCarthy SW, Thompson JF, Scolyer RA. Sentinel lymph nodes containing very small (<0.1 mm) deposits of metastatic melanoma cannot be safely regarded as tumor-negative. Ann Surg Oncol 2012; 19:1089-99. [PMID: 22271204 DOI: 10.1245/s10434-011-2208-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Some authors have suggested that patients with very small (<0.1 mm) deposits of metastatic melanoma in sentinel lymph nodes (SLNs) should be considered SLN-negative, whereas others have reported that such patients can have adverse long-term outcomes. The aims of the present study were to determine whether extensive sectioning of SLNs resulted in more accurate categorization of histologic features of tumor deposits and to assess prognostic associations of histologic parameters obtained using more intensive sectioning protocols. METHODS From patients with a single primary cutaneous melanoma who underwent SLN biopsy between 1991 and 2008, those in which the maximum size of the largest tumor deposit (MaxSize) in SLNs was <0.1 mm in the original sections were identified. Five batches of additional sections were cut from the SLN tissue blocks at intervals of 250 μm. The 1st batch was cut from the blocks without any trimming; these sections were therefore immediately adjacent to the original sections. Each batch included 5 sequential sections, the 1st and 5th stained with hematoxylin-eosin, and the 2nd, 3rd, and 4th stained immunohistochemically with S-100, HMB-45, and Melan-A, respectively. In each batch of sections, the following histologic features of tumor deposit(s) in the SLNs were evaluated: MaxSize; tumor penetrative depth (TPD) (defined as the maximum depth of tumor deposit(s) from the inner margin of the lymph node capsule), and intranodal location (classified as subcapsular if the tumor deposit(s) were confined to the subcapsular zone or parenchymal if there was any involvement of the nodal parenchyma beyond the subcapsular zone). The measured histologic parameters were compared in each batch of sections. The association of histologic parameters with overall survival was assessed for the parameters measured in each batch of sections. RESULTS There were 20 eligible patients (15 females, 5 males, median age 60 years). After a median follow-up duration of 40 months, 4 patients had died from melanoma and 2 patients of unknown causes. Completion lymph node dissection (CLND) was performed in 13 cases (65%) and was negative in all cases. Relative to the measured values on the original sections, all 3 parameters were upstaged in subsequent batches of sections, but no further upstaging of MaxSize, TPD, or location was seen beyond batch 3, batch 4, and batch 2, respectively. Increasing MaxSize was associated with significantly poorer overall survival in batches 1, 2, and 3. Parenchymal involvement was significantly associated with poorer survival in batches 2-5. TPD was not significantly associated with overall survival. CONCLUSIONS The results of this study indicate that very small (<0.1 mm) deposits of melanoma in SLNs may be associated with adverse clinical outcomes and that this is due, at least in part, to the underestimation of SLN tumor burden in the initial sections. Our evidence does not support clinical decision-making on the assumption that patients with very small melanoma deposits in SLNs have the same outcome as those who are SLN-negative.
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Affiliation(s)
- Rajmohan Murali
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Riber-Hansen R, Vainer B, Steiniche T. Digital image analysis: a review of reproducibility, stability and basic requirements for optimal results. APMIS 2011; 120:276-89. [PMID: 22429210 DOI: 10.1111/j.1600-0463.2011.02854.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Digital image analysis (DIA) is increasingly implemented in histopathological research to facilitate truly quantitative measurements, decrease inter-observer variation and reduce hands-on time. Originally, efforts were made to enable DIA to reproduce manually obtained results on histological slides optimized for light microscopy and the human eye. With improved technical methods and the acknowledgement that computerized readings are different from analysis by human eye, recognition has been achieved that to really empower DIA, histological slides must be optimized for the digital 'eye', with reproducible results correlating with clinical findings. In this review, we focus on the basic expectations and requirements for DIA to gain wider use in histopathological research and diagnostics. With a reference to studies that specifically compare DIA with conventional methods, this review discusses reproducibility, application of stereology-based quantitative measurements, time consumption, optimization of histological slides, regions of interest selection and recent developments in staining and imaging techniques.
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Linos K, Slominski A, Ross JS, Carlson JA. Melanoma update: diagnostic and prognostic factors that can effectively shape and personalize management. Biomark Med 2011; 5:333-60. [PMID: 21657842 DOI: 10.2217/bmm.11.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Routine light microscopy remains a powerful tool to diagnose, stage and prognose melanoma. Although it is very economical and efficient, it requires a significant level of expertise and, in difficult cases the final diagnosis is affected by subjective interpretation. Fortunately, new insights into the genomic aberrations characteristic of melanoma, coupled with ancillary studies, are further refining evaluation and management allowing for more confident diagnosis, more accurate staging and the selection of targeted therapy. In this article, we review the standard of care and new updates including four probe FISH, the 2009 American Joint Commission on Cancer staging of melanoma and mutant testing of melanoma, which will be crucial for targeted therapy of metastatic melanoma.
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Murali R, Thompson JF, Scolyer RA. Location of melanoma metastases in sentinel lymph nodes: what are the implications for histologic processing of sentinel lymph nodes in routine practice? Am J Surg Pathol 2010; 34:127-9; author reply 129-31. [PMID: 20035152 DOI: 10.1097/pas.0b013e3181c70ee8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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In Response:. Am J Surg Pathol 2010. [DOI: 10.1097/pas.0b013e3181c71037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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