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Schmidt M, Hohberg M, Felcht M, Kühn T, Eichbaum M, Krause BJ, Zöphel BK, Kotzerke J. [Nuclear medicine procedure guideline for sentinel lymph node localization]. Nuklearmedizin 2024. [PMID: 38788776 DOI: 10.1055/a-2319-8306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma, in breast cancer, in penile and vulva tumors, in head and neck cancer, and in prostate carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node or distant metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. New aspects in this guideline are new radiopharmaceuticals such as tilmanocept and Tc-99m-PSMA and SPECT/CT allowing an easier anatomical orientation. Initial dynamic lymphoscintigraphy in breast cancer is of little significance nowadays. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. A one-day protocol should preferentially be used. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance. Aspects of quality control were included (scintigraphy, quality control of gamma probe, 6 h SLN course for surgeons, certified breast centers, medical surveillance center).
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Affiliation(s)
- M Schmidt
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln
| | - M Hohberg
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln
| | - M Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim (Vertreter der DDG)
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen (Vertreter der DGGG - Mamma-Ca)
| | - M Eichbaum
- Klinik für Gynäkologie und gynäkologische Onkologie, Helios Dr.-Horst-Schmidt-Kliniken Wiesbaden (Vertreter der DGGG - Genitaltumoren)
| | - B J Krause
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Rostock
| | - B K Zöphel
- Klinik für Nuklearmedizin, Klinikum Chemnitz
| | - J Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Dresden
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2
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Roumen RMH, Schuurman MS, Aarts MJ, Maaskant-Braat AJG, Vreugdenhil G, Louwman WJ. Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study. PLoS One 2021; 16:e0252021. [PMID: 34033662 PMCID: PMC8148374 DOI: 10.1371/journal.pone.0252021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background The Multicenter Selective Lymphadenectomy Trial (MSLT-1) comparing survival after a sentinel lymph node biopsy (SLNB) versus nodal observation in melanoma patients did not show a significant benefit favoring SLNB. However, in subgroup analyses melanoma-specific survival among patients with nodal metastases seemed better. Aim To evaluate the association of performing a SLNB with overall survival in intermediate thickness melanoma patients in a Dutch population-based daily clinical setting. Methods Survival, excess mortality adjusted for age, gender, Breslow-thickness, ulceration, histological subtype, location, co-morbidity and socioeconomic status were calculated in a population of 1,989 patients diagnosed with malignant cutaneous melanoma (1.2–3.5 mm) on the trunk or limb between 2000–2016 in ten hospitals in the South East area, The Netherlands. Results A SLNB was performed in 51% of the patients (n = 1008). Ten-year overall survival after SLNB was 75% (95%CI, 71%-78%) compared to 61% (95%CI 57%-64%) following observation. After adjustment for risk factors, a lower risk on death (HR = 0.80, 95%CI 0.66–0.96) was found after SLNB compared to observation only. Conclusions SLNB in patients with intermediate-thickness melanoma on trunk or limb resulted in a 14% absolute and significant 10-year survival difference compared to those without SLNB.
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Affiliation(s)
- R. M. H. Roumen
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- GROW–School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - M. S. Schuurman
- Netherlands Comprehensive Cancer Organization, IKNL, Utrecht, The Netherlands
| | - M. J. Aarts
- Netherlands Comprehensive Cancer Organization, IKNL, Utrecht, The Netherlands
| | | | - G. Vreugdenhil
- Department of Medical Oncology, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | - W. J. Louwman
- Netherlands Comprehensive Cancer Organization, IKNL, Utrecht, The Netherlands
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Klemen ND, Han G, Leong SP, Kashani‐Sabet M, Vetto J, White R, Schneebaum S, Pockaj B, Mozzillo N, Charney K, Hoekstra H, Sondak VK, Messina JL, Zager JS, Han D. Completion lymphadenectomy for a positive sentinel node biopsy in melanoma patients is not associated with a survival benefit. J Surg Oncol 2019; 119:1053-1059. [DOI: 10.1002/jso.25444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/03/2019] [Accepted: 02/26/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Nicholas D. Klemen
- Section of Surgical OncologyYale School of MedicineNew Haven Connecticut
| | - Gang Han
- Department of Epidemiology and BiostatisticsSchool of Public Health, Texas A&M UniversityCollege Station Texas
| | - Stanley P. Leong
- California Pacific Medical Center and Research InstituteSan Francisco California
| | | | - John Vetto
- Division of Surgical OncologyOregon Health & Science UniversityPortland Oregon
| | - Richard White
- Levine Cancer InstituteCarolinas Medical CenterCharlotte North Carolina
| | | | | | | | - Kim Charney
- St. Joseph Hospital of OrangeOrange California
| | | | | | | | | | - Dale Han
- Division of Surgical OncologyOregon Health & Science UniversityPortland Oregon
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Wollina U, Brzezinski P. The value of metastasectomy in stage IV cutaneous melanoma. Wien Med Wochenschr 2018; 169:331-338. [PMID: 29511905 DOI: 10.1007/s10354-018-0630-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/13/2018] [Indexed: 12/27/2022]
Abstract
Cutaneous melanoma is an aggressive neoplasia of melanocytes. Prognosis is dependent on tumor stage. Stage IV melanoma is characterized by the occurrence of distant metastases. Response of metastases to classical chemotherapy is limited and toxicity of treatment is high. In recent years, new developments in immunotherapy and targeted therapies improved prognosis of stage IV melanoma patients with better tolerability of treatment. There is no dispute about surgical treatment of primary melanoma. But what is the value of metastasectomy in the era of new systemic treatments? This review aims to discuss available data for surgical removal of distant metastases for several organs and tissues. The available evidence suggests that for selected patients with possible complete resection of all tumor metastases, metastasectomy remains an effective treatment option with a benefit in overall survival.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstraße 41, 01067, Dresden, Germany.
| | - Piotr Brzezinski
- Faculty of Mathematics and Natural Sciences, Institute of Biology and Environmental Protection, Pomeranian Academy, 76-200, Slupsk, Poland.,Department of Dermatology, 6th Military Support Unit, os. Ledowo 1N, 76-270, Ustka, Poland
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5
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Madu M, Wouters M, van Akkooi A. Sentinel node biopsy in melanoma: Current controversies addressed. Eur J Surg Oncol 2017; 43:517-533. [DOI: 10.1016/j.ejso.2016.08.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
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6
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Yu Y, Song Z, Xu Z, Ye X, Xue C, Li J, Bi H. Bilayered negative-pressure wound therapy preventing leg incision morbidity in coronary artery bypass graft patients: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e5925. [PMID: 28099357 PMCID: PMC5279102 DOI: 10.1097/md.0000000000005925] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUNDS The harvesting of great saphenous veins for coronary artery bypass graft (CABG) patients may result in significant complications, including lymphorrhagia, lymphoedema, incision infection, wound dehiscence, and skin flap necrosis. We investigated the function of a self-designed bilayered negative pressure wound therapy (b-NPWT) for reducing the above-mentioned complications using a clinical randomized controlled trial. METHODS A single-center, pilot randomized controlled trial was conducted. From December 2013 to March 2014, a total of 72 coronary heart disease patients (48 men and 24 women) received CABG therapy, with great saphenous veins were selected as grafts. Patients were equally randomized into a treatment and a control group. After the harvesting of the great saphenous veins and direct closure of the wound with sutures, b-NPWT was used for the thigh incision in the treatment group for 5 days (treatment thigh). Traditional surgical pads were applied to both the shank incisions of the treatment group patients (treatment shank) and the entire incisions of the control group (control thigh, control shank). Postoperative complications were recorded and statistically analyzed based on outcomes of thigh treatment, shank treatment, thigh control, and shank control groups. RESULTS The incidence rates of early complications, such as lymphorrhagia, lymphoedema, infection, wound dehiscence, and skin flap necrosis, of the vascular donor site in the thigh treatment group was significantly lower than those in the 3 other groups. CONCLUSIONS The self-designed b-NPWT can effectively reduce postoperative complications, such as lymphedema, incision infection, wound dehiscence, and skin flap necrosis, in CABG patients who underwent great saphenous veins harvesting. TRIAL REGISTRATION ClinicalTrials.gov. The unique registration number is NCT02010996.
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Affiliation(s)
| | | | | | - Xiaofei Ye
- Department of Statistics, Faculty of Medical Services
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Junhui Li
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hongda Bi
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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7
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Costa Svedman F, Spanopoulos D, Taylor A, Amelio J, Hansson J. Surgical outcomes in patients with cutaneous malignant melanoma in Europe - a systematic literature review. J Eur Acad Dermatol Venereol 2016; 31:603-615. [DOI: 10.1111/jdv.13950] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/11/2016] [Indexed: 02/03/2023]
Affiliation(s)
- F. Costa Svedman
- Karolinska Institutet; Karolinska University Hospital Solna; Stockholm Sweden
| | - D. Spanopoulos
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - A. Taylor
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - J. Amelio
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - J. Hansson
- Karolinska Institutet; Karolinska University Hospital Solna; Stockholm Sweden
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Geimer T, Sattler E, Flaig M, Ruzicka T, Berking C, Schmid-Wendtner M, Kunte C. The impact of sentinel node dissection on disease-free and overall tumour-specific survival in melanoma patients: a single centre group-matched analysis of 1192 patients. J Eur Acad Dermatol Venereol 2016; 31:629-635. [DOI: 10.1111/jdv.13939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- T. Geimer
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - E.C. Sattler
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - M.J. Flaig
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - T. Ruzicka
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - C. Berking
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - M.H. Schmid-Wendtner
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
- Interdisciplinary Oncology Center Munich; Munich Germany
| | - C. Kunte
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
- Department for Dermatologic Surgery and Dermatology; Artemed Clinic; Munich Germany
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9
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Santos-Juanes J, Fernández-Vega I, Galache Osuna C, Coto-Segura P, Martínez-Camblor P. Sentinel lymph node biopsy plus wide local excision vs. wide location excision alone for primary cutaneous melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2016; 31:241-246. [PMID: 27592851 DOI: 10.1111/jdv.13824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy and wide local excision of the primary melanoma (SLNB) is now a standard staging procedure for patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear. OBJECTIVE To determine whether there is an association between performance of SLNB and patient prognosis. METHODS Studies assessing the association between performance of SLNB and patient prognosis were pooled from MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar. From each study, first author's last name, publication year, origin country, type of study design, characteristics of participants and the Hazard risk (HR) for melanoma specific survival (MSS) with the corresponding 95% confidence interval (95% CI) were collected. Methodological assessment of the studies was evaluated using the Newcastle-Ottawa scale (NOS) and the 'Risk of bias' tool detailed in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses for the global HR were performed. In addition, in order to explore the sources of heterogeneity among the studies, sensitivity analyses are also provided. RESULTS A total of six studies with 8764 patients who had undergone SLNB and 11054 patients who had undergone wide location excision alone (WLEA) were identified for the analysis. The indicators suggest that the heterogeneity is low: τ2 = 0; H = 1 [1; 1.74]; I2 = 0% [0%; 66.5%]. Evidence for publication bias was not found (Egger's test P = 0.4654). The pooled MSS HR from fixed effects analysis was determined to be 0.88 (95% CI = 0.80-0.96). CONCLUSIONS Although no significant survival difference was observed in four of the six series, the pooling summary data from all the studies that deal with this issue suggested that SLNB is associated with a significantly better outcome compared with WLEA for localized melanoma.
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Affiliation(s)
- J Santos-Juanes
- Dermatology II Department of Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Fernández-Vega
- Pathology Department of Hospital Universitario Araba, Álava, Spain
| | - C Galache Osuna
- Departamento de Radiodiagnóstico, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Coto-Segura
- Dermatology II Department of Hospital Universitario Central de Asturias, Oviedo, Spain
| | - P Martínez-Camblor
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Universidad Autónoma de Chile, Santiago, Chile
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10
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Ipenburg NA, Nieweg OE, Uren RF, Thompson JF. Outcome of Melanoma Patients Who Did Not Proceed to Sentinel Node Biopsy After Preoperative Lymphoscintigraphy. Ann Surg Oncol 2016; 24:117-126. [PMID: 27480356 DOI: 10.1245/s10434-016-5458-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND At our institution, a planned sentinel node biopsy (SNB) procedure is occasionally canceled after preoperative lymphoscintigraphy. This study reports the frequency of this, the reasons, and the management and outcomes of these patients. METHODS All patients with clinically localized cutaneous melanoma treated at Melanoma Institute Australia between 2000 and 2009 whose planned SNB procedure was not undertaken after lymphoscintigraphy were included in this retrospective study. RESULTS Of the 3148 patients in whom the procedure had been planned, 203 patients (6.4 %) did not have a SNB. The main reason for not proceeding with SNB (in 84 % of cases) was the lymphoscintigraphic demonstration of multiple drainage fields and/or multiple sentinel nodes (SNs). Patients who did not proceed to SNB were significantly older than those who did, more often had melanomas of the head or neck, and had more SNs and more nodal drainage fields. Of the 203 patients, 181 (89 %) were followed with high-resolution ultrasound of their SNs, which identified 33 % of the nodal recurrences before they were clinically apparent. Patients whose SNB was canceled had significantly worse recurrence-free survival and regional node disease-free survival, but melanoma-specific survival was similar. Compared to SN-positive patients, node-positive patients without SNB had significantly more involved nodes when a delayed lymphadenectomy was performed, but melanoma-specific survival was not significantly different after a median follow-up of 42 months. CONCLUSIONS Lymphoscintigraphy with ultrasound follow-up of previously identified SNs is an acceptable management strategy for patients in whom a SNB procedure is likely to be challenging.
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Affiliation(s)
| | - Omgo E Nieweg
- Melanoma Institute Australia, North Sydney, NSW, Australia. .,Central Medical School, The University of Sydney, Sydney, NSW, Australia. .,The Mater Hospital, North Sydney and Royal Prince Alfred Hospital, Camperdown, Australia.
| | - Roger F Uren
- Central Medical School, The University of Sydney, Sydney, NSW, Australia.,Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Newtown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Central Medical School, The University of Sydney, Sydney, NSW, Australia.,The Mater Hospital, North Sydney and Royal Prince Alfred Hospital, Camperdown, Australia
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11
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Koskivuo I, Vihinen P, Mäki M, Talve L, Vahlberg T, Suominen E. Improved Survival in Male Melanoma Patients in the Era of Sentinel Node Biopsy. Scand J Surg 2016; 106:80-86. [PMID: 26929285 DOI: 10.1177/1457496916631852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Sentinel node biopsy is a standard method for nodal staging in patients with clinically localized cutaneous melanoma, but the survival advantage of sentinel node biopsy remains unsolved. The aim of this case-control study was to investigate the survival benefit of sentinel node biopsy. MATERIALS AND METHODS A total of 305 prospective melanoma patients undergoing sentinel node biopsy were compared with 616 retrospective control patients with clinically localized melanoma whom have not undergone sentinel node biopsy. Survival differences were calculated with the median follow-up time of 71 months in sentinel node biopsy patients and 74 months in control patients. Analyses were calculated overall and separately in males and females. RESULTS Overall, there were no differences in relapse-free survival or cancer-specific survival between sentinel node biopsy patients and control patients. Male sentinel node biopsy patients had significantly higher relapse-free survival ( P = 0.021) and cancer-specific survival ( P = 0.024) than control patients. In females, no differences were found. Cancer-specific survival rates at 5 years were 87.8% in sentinel node biopsy patients and 85.2% in controls overall with 88.3% in male sentinel node biopsy patients and 80.6% in male controls and 87.3% in female sentinel node biopsy patients and 89.8% in female controls. CONCLUSION Sentinel node biopsy did not improve survival in melanoma patients overall. While females had no differences in survival, males had significantly improved relapse-free survival and cancer-specific survival following sentinel node biopsy.
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Affiliation(s)
- I Koskivuo
- 1 Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - P Vihinen
- 2 Department of Oncology, Turku University Hospital, Turku, Finland
| | - M Mäki
- 3 Department of Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - L Talve
- 4 Department of Pathology, Turku University Hospital, Turku, Finland
| | - T Vahlberg
- 5 Department of Biostatistics, University of Turku, Turku, Finland
| | - E Suominen
- 1 Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
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12
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Sperry SM, Charlton ME, Pagedar NA. Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database. JAMA Otolaryngol Head Neck Surg 2015; 140:1101-9. [PMID: 25321889 DOI: 10.1001/jamaoto.2014.2530] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated. OBJECTIVE To assess the association of SLNB with survival for melanoma arising in head and neck subsites (HNM). DESIGN, SETTING, AND PARTICIPANTS Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare US patients with HNM meeting current recommendations for SLNB, treated from 2004 to 2011 with either (1) SLNB with or without neck dissection, or (2) no SLNB or neck dissection. INTERVENTIONS SLNB with or without neck dissection. MAIN OUTCOMES AND MEASURES Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional hazards modeling to compare survival outcomes between matched pair cohorts. RESULTS A total of 7266 patients with HNM meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed using propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin, >0.75-1.00 mm Breslow thickness; intermediate, >1.00-4.00 mm; and thick, >4.00 mm) and exactly matched within 5 age categories. In the intermediate-thickness cohort, 2808 patients with HNM were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs 88% for nodal observation (log-rank P = .30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI, 0.66-1.14; P = .31). In each of the other cohorts analyzed, including those with thin and thick melanomas, and cohorts with melanoma overall, no significant difference in DSS was demonstrated. CONCLUSIONS AND RELEVANCE This SEER cohort analysis demonstrates no significant association between SLNB and improved disease-specific survival for patients with HNM.
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Affiliation(s)
- Steven M Sperry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Mary E Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
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13
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Krediet J, Beyer M, Lenz K, Ulrich C, Lange-Asschenfeldt B, Stockfleth E, Terhorst D. Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma. Br J Dermatol 2015; 172:1029-36. [DOI: 10.1111/bjd.13508] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 01/28/2023]
Affiliation(s)
- J.T. Krediet
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - M. Beyer
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - K. Lenz
- Institute of Biometry and Epidemiology; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - C. Ulrich
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - B. Lange-Asschenfeldt
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - E. Stockfleth
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
- Clinic for Dermatology; Venerology and Allergology; St. Josef-Hospital Bochum - University Hospital of the Ruhr-Universität Bochum; 44791 Bochum Germany
| | - D. Terhorst
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
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14
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van der Ploeg APT, Haydu LE, Spillane AJ, Quinn MJ, Saw RP, Shannon KF, Stretch JR, Uren RF, Scolyer RA, Thompson JF. Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution. Ann Surg 2014; 260:149-57. [PMID: 24633018 DOI: 10.1097/sla.0000000000000500] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort. METHODS Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months. RESULTS Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041). CONCLUSIONS In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.
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Affiliation(s)
- Augustinus P T van der Ploeg
- *Melanoma Institute Australia †Sydney Medical School, The University of Sydney, Sydney ‡Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, Newtown, New South Wales, Australia
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15
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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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Sattler E, Geimer T, Sick I, Flaig MJ, Ruzicka T, Berking C, Kunte C. Sentinel lymph node in Merkel cell carcinoma: To biopsy or not to biopsy? J Dermatol 2013; 40:374-9. [DOI: 10.1111/1346-8138.12072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Elke Sattler
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Till Geimer
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Isabell Sick
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Michael J. Flaig
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Carola Berking
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Christian Kunte
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
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Beger J, Hansel G, Krönert C, Fuchs M, Tanner C, Schönlebe J, Werner C, Nowak A, Haroske G, Witzigmann H, Wollina U. A 10-year analysis of primary cutaneous malignant melanoma with sentinel lymph node biopsy and long-term follow-up. Int J Dermatol 2013; 52:220-30. [DOI: 10.1111/j.1365-4632.2012.05706.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Josefine Beger
- Departments/Institutes of the Academic Teaching Hospital; Dresden-Friedrichstadt, Dresden
| | - Gesina Hansel
- Departments/Institutes of the Academic Teaching Hospital; Dresden-Friedrichstadt, Dresden
| | - Claudia Krönert
- Departments/Institutes of the Academic Teaching Hospital; Dresden-Friedrichstadt, Dresden
| | - Martin Fuchs
- Clinic for Nuclear Medicine Fuchs & Tanner; Dresden, Technical University of Dresden; Dresden; Germany
| | - Carmen Tanner
- Clinic for Nuclear Medicine Fuchs & Tanner; Dresden, Technical University of Dresden; Dresden; Germany
| | - Jaqueline Schönlebe
- Departments/Institutes of the Academic Teaching Hospital Dresden-Friedrichstadt; Dresden; Germany
| | - Carmen Werner
- Regional Clinical Cancer Registry; Technical University of Dresden; Dresden; Germany
| | - Andreas Nowak
- Departments/Institutes of the Academic Teaching Hospital Dresden-Friedrichstadt; Dresden; Germany
| | - Gunter Haroske
- Departments/Institutes of the Academic Teaching Hospital Dresden-Friedrichstadt; Dresden; Germany
| | - Helmut Witzigmann
- Departments/Institutes of the Academic Teaching Hospital Dresden-Friedrichstadt; Dresden
| | - Uwe Wollina
- Departments/Institutes of the Academic Teaching Hospital; Dresden-Friedrichstadt, Dresden
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18
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Levine SM, Shapiro RL. Surgical treatment of malignant melanoma: practical guidelines. Dermatol Clin 2012; 30:487-501. [PMID: 22800553 DOI: 10.1016/j.det.2012.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Melanoma is currently the fifth and sixth most common solid malignancy diagnosed in men and women, respectively. Although accounting for only 4% of cases of all cutaneous malignancies, melanoma accounts for more than 75% of all deaths from skin cancer. This article discusses epidemiology and risk factors, proper biopsy technique, advanced histologic evaluation of biopsy material, assessment of tumor thickness and staging, preoperative metastatic evaluation, excision margin, treatment of regional lymph nodes, treatment of recurrence, and some special clinical situations.
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Affiliation(s)
- Steven M Levine
- Institute of Reconstructive Plastic Surgery, Department of Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA
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Setting up an effective and efficient sentinel node biopsy service for malignant melanoma within the NHS. J Plast Reconstr Aesthet Surg 2011; 65:351-5. [PMID: 22178369 DOI: 10.1016/j.bjps.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/31/2011] [Accepted: 11/06/2011] [Indexed: 11/24/2022]
Abstract
Sentinel lymph node biopsy provides prognostic information for melanoma patients, and the Department of Health states that it should be available across the country by 2012. We review the setting up of a melanoma sentinel lymph node biopsy service with specific consideration to resources, service implications and patient outcomes. In total, 164 patients underwent sentinel lymph node biopsy for melanoma from August 2008 until March 2010. The median time for sentinel lymph node excision was 26 min. The median total operative time, which includes melanoma excision and sentinel node biopsy was 65 min, compared with 22 min for excision of the melanoma performed during the previous 19 months. The complication rate was 8.5%, with only 1.2% requiring operative treatment. After the initial outlay for two gamma probes, it was possible to deliver a cost neutral service within the National Tariff. Despite a significant increase in demand for the service in the second half of the study period, and 106% increase in the number of regional lymphadenectomies, only 1 patient (0.6%) breached the 'Going Further on Cancer Waits' target. In conclusion, a sentinel lymph node biopsy service for malignant melanoma can be effectively delivered within the majority of UK plastic surgery departments.
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Stoffels I, von der Stück H, Boy C, Pöppel T, Körber N, Weindorf M, Dissemond J, Schadendorf D, Klode J. Indocyanine green fluorescence-guided sentinel lymph node biopsy in dermato-oncology. J Dtsch Dermatol Ges 2011; 10:51-7. [PMID: 22103392 DOI: 10.1111/j.1610-0387.2011.07843.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) for cutaneous malignancies usually carried out with radioactive nanocolloids (Tc-99m). The SLNE is controversially discussed internationally. This is especially given to the high false-negative rate up to 44 %. An alternative could be the fluorescent dye indocyanine green (ICG). MATERIAL AND METHODS We investigated the advantage of intraoperative fluorescence detection of lymphatic vessels and SLN with a Near-Infrared (NIR) camera in comparison to conventional methods using preoperative lymphoscintigraphy and SPECT/CT in 22 patients with malignant melanoma. RESULTS A total of 61 SLNs were removed in 22 operative procedures. In 7 SLN (10.3 %; 7/68) the histopathological assessment could demonstrate a metasta-tic involvement. 11 additional SLN (19.1 %) in 8 patients were only identified using the fluorescent labeling. Two of these additional SLN (9.1 %; 2/22) showed metastatic involvement. CONCLUSION The ICG fluorescence-guided SLNB is an innovative imaging technique for dermato-oncology, reliable and providing additional information in the detection of SLN. Therefore SLNB with fluorescence-dye is an attractive option with intraoperative real-time lymphoscintigraphy to improve the detection of SLN in cutaneous malignancies and potential reduction of the false negative rate in SLN.
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Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University of Essen-Duisburg, Germany
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Liu LC, Parrett BM, Jenkins T, Lee W, Morita E, Treseler P, Huang L, Thummala S, Allen RE, Kashani-Sabet M, Leong SPL. Selective sentinel lymph node dissection for melanoma: importance of harvesting nodes with lower radioactive counts without the need for blue dye. Ann Surg Oncol 2011; 18:2919-24. [PMID: 21468784 DOI: 10.1245/s10434-011-1689-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Determining how many sentinel lymph nodes (SLNs) should be removed for melanoma is important. The purpose of this study is to determine the frequency at which nodes that are less radioactive than the "hottest" node (which is negative) are positive for melanoma, how low of a radioactivity should warrant harvest, and if isosulfan blue is necessary. METHODS We reviewed 1,152 melanoma patients who underwent lymphoscintigraphy with technetium, with or without blue dye, and SLN dissection from 1996 to 2008. SLNs with radioactivity ≥10% of the "hottest" SLN, all blue nodes, and all suspicious nodes were removed and analyzed. The miss rate was calculated as the proportion of node positive cases in which the "hottest" SLN was negative. RESULTS SLNs were identified in 1,520 nodal basins in 1,152 patients. SLN micrometastases were detected in 218 basins (14%) in 204 patients (18%). In 16% of SLN-positive patients (33/204 patients), the positive SLN was found to have a lower radioactive count than the "hottest" SLN, which was negative. In 21 of these cases, the positive SLNs had radioactivity ≤50% of the "hottest" SLN. The 10% rule significantly reduced the miss rate to 2.5% compared with removal of only the "hottest" SLN (miss rate = 16%). Also, blue dye did not significantly decrease the miss rate compared with radiocolloid alone using the 10% rule. CONCLUSIONS To decrease the miss rate, all SLNs with ≥10% of the ex vivo radioactivity of the "hottest" SLN should be removed and blue dye is not essential.
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Affiliation(s)
- Liang-Chih Liu
- Department of Surgery, University of California, San Francisco, CA, USA
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Wu X, Takekoshi T, Sullivan A, Hwang ST. Inflammation and tumor microenvironment in lymph node metastasis. Cancers (Basel) 2011; 3:927-44. [PMID: 24212647 PMCID: PMC3756397 DOI: 10.3390/cancers3010927] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 11/17/2022] Open
Abstract
In nearly all human cancers, the presence of lymph node (LN) metastasis increases clinical staging and portends worse prognosis (compared to patients without LN metastasis). Herein, principally reviewing experimental and clinical data related to malignant melanoma, we discuss diverse factors that are mechanistically involved in LN metastasis. We highlight recent data that link tumor microenvironment, including inflammation (at the cellular and cytokine levels) and tumor-induced lymphangiogenesis, with nodal metastasis. Many of the newly identified genes that appear to influence LN metastasis facilitate general motility, chemotactic, or invasive properties that also increase the ability of cancer cells to disseminate and survive at distant organ sites. These new biomarkers will help predict clinical outcome and point to novel future therapies in metastatic melanoma as well as other cancers.
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Affiliation(s)
- Xuesong Wu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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