Top

Annals of Surgical Oncology

Published in:

01-06-2008 | Melanomas

Criteria in Sentinel Lymph Nodes of Melanoma Patients that Predict Involvement of Nonsentinel Lymph Nodes

Authors: Imke Satzger, Bernward Völker, Andre Meier, Alexander Kapp, Ralf Gutzmer

Published in: Annals of Surgical Oncology | Issue 6/2008

Abstract

Background

Previous studies described various criteria in sentinel lymph nodes (SLN) of melanoma patients that predict the involvement of further, nonsentinel lymph nodes (NSLN). Such criteria may facilitate the selection of patients who might benefit from a completion lymph node dissection (CLND). However, it is currently unclear which parameters are most important.

Methods

A total of 180 melanoma patients with positive SLNB and subsequent CLND were investigated. Histopathologic parameters in the SLN were systematically evaluated and compared with regard to NSLN positivity. Twenty-eight of these patients (16.0%) had positive NSLN.

Results

By univariate analysis several criteria with regard to tumor burden and location of melanoma cells in the SLN correlated with NSLN involvement, such as positivity by hematoxylin-eosin (H&E) staining (P < .001), largest diameter of clusters (P < .001), capsular involvement (P = .001), extranodal extension (P < .001), and tumor penetrative depth (P < .001). Multivariate analysis revealed three independent parameters: (1) positivity of the SLN by H&E staining (versus by immunohistochemistry alone), (2) relative tumor burden >10% of total lymph node tissue, and (3) perinodal intralymphatic tumor. In 23 of 28 patients with positive NSLN the SLN was positive by H&E staining, in 15 of 28 patients the relative tumor burden was >10%, and 13 of 28 showed perinodal intralymphatic tumor. In 5 of 28 patients with NSLN involvement, these three parameters were negative.

Conclusions

Histopathologic examination of the SLN can identify patients at risk for NSLN positivity.

Morton DL, Wen DR, Foshag LJ, et al. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol 1993;11:1751–6PubMed

Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–83PubMed

Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:3622–34PubMed

Essner R, Conforti A, Kelley MC, et al. Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999;6:442–9PubMedCrossRef

Satzger I, Volker B, Meier A, et al. Prognostic significance of isolated HMB45 or Melan A positive cells in Melanoma sentinel lymph nodes. Am J Surg Pathol 2007;31:1175–80PubMedCrossRef

Cochran AJ, Wen DR, Huang RR, et al. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol 2004;17:747–55PubMedCrossRef

Dewar DJ, Newell B, Green MA, et al. The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004;22:3345–9PubMedCrossRef

Fink AM, Weihsengruber F, Spangl B, et al. S-classification of sentinel lymph node biopsy predicts the results of complete regional lymph node dissection. Melanoma Res 2005;15:267–71PubMedCrossRef

Lee JH, Essner R, Torisu-Itakura H, et al. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol 2004;22:3677–84PubMedCrossRef

10.

Sabel MS, Griffith K, Sondak VK, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg 2005;201:37–47PubMedCrossRef

11.

Salti GI, Das Gupta TK. Predicting residual lymph node basin disease in melanoma patients with sentinel lymph node metastases. Am J Surg 2003;186:98–101PubMedCrossRef

12.

Scolyer RA, Li LX, McCarthy SW, et al. Micromorphometric features of positive sentinel lymph nodes predict involvement of nonsentinel nodes in patients with melanoma. Am J Clin Pathol 2004;122:532–9PubMedCrossRef

13.

van Akkooi AC, de Wilt JH, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol 2006;17:1578–85PubMedCrossRef

14.

Vuylsteke RJ, Borgstein PJ, van Leeuwen PA, et al. Sentinel lymph node tumor load: an independent predictor of additional lymph node involvement and survival in melanoma. Ann Surg Oncol 2005;12:440–8PubMedCrossRef

15.

Wagner JD, Davidson D, Coleman JJ III, et al. Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma. Ann Surg Oncol 1999;6:398–404PubMedCrossRef

16.

Carlson GW, Murray DR, Lyles RH, et al. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol 2003;10:575–81PubMedCrossRef

17.

McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol 2002;9:137–41PubMedCrossRef

18.

Reeves ME, Delgado R, Busam KJ, et al. Prediction of nonsentinel lymph node status in melanoma. Ann Surg Oncol 2003;10:27–31PubMedCrossRef

19.

Starz H, Siedlecki K, Balda BR. Sentinel lymphonodectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol 2004;11:162S–8SPubMed

20.

Gutzmer R, Kaspari M, Brodersen JP, et al. Specificity of tyrosinase and HMB45 PCR in the detection of melanoma metastases in sentinel lymph node biopsies. Histopathology 2002;41:510–8PubMedCrossRef

21.

Scolyer RA, Li LX, McCarthy SW, et al. Immunohistochemical stains fail to increase the detection rate of micrometastatic melanoma in completion regional lymph node dissection specimens. Melanoma Res 2004;14:263–8PubMedCrossRef

22.

Cochran AJ, Balda BR, Starz H, et al. The Augsburg Consensus. Techniques of lymphatic mapping, sentinel lymphadenectomy, and completion lymphadenectomy in cutaneous malignancies. Cancer 2000;89:236–41PubMedCrossRef

23.

Cserni G. Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up. J Clin Pathol 1999;52:922–4PubMed

24.

van Diest PJ. Histopathological workup of sentinel lymph nodes: how much is enough? J Clin Pathol 1999;52:871–3PubMedCrossRef

25.

Shidham VB, Qi DY, Acker S, et al. Evaluation of micrometastases in sentinel lymph nodes of cutaneous melanoma: higher diagnostic accuracy with Melan-A and MART-1 compared with S-100 protein and HMB-45. Am J Surg Pathol 2001;25:1039–46PubMedCrossRef

26.

Kiehl P, Falkenberg K, Vogelbruch M, et al. Quantification of eosinophilic granule protein deposition in biopsies of inflammatory skin diseases by automated image analysis of highly sensitive immunostaining. Anal Cell Pathol 1999;19:153–62PubMed

27.

Kiehl P, Falkenberg K, Vogelbruch M, et al. Tissue eosinophilia in acute and chronic atopic dermatitis: a morphometric approach using quantitative image analysis of immunostaining. Br J Dermatol 2001;145:720–9PubMedCrossRef

28.

Starz H, Balda BR, Kramer KU, et al. A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001;91:2110–21PubMedCrossRef

29.

Morton DL. Sentinel node mapping and an International Sentinel Node Society: current issues and future directions. Ann Surg Oncol 2004;11:137S–43SPubMed

30.

Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006;355:1307–17PubMedCrossRef

31.

32.

Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9PubMed

33.

van Akkooi AC, de Wilt JH, Verhoef C, et al. High positive sentinel node identification rate by EORTC melanoma group protocol. Prognostic indicators of metastatic patterns after sentinel node biopsy in melanoma. Eur J Cancer 2006;42:372–80PubMedCrossRef

34.

Yee VS, Thompson JF, McKinnon JG, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol 2005;12:429–39PubMedCrossRef

35.

Satzger I, Volker B, Al Ghazal M, et al. Prognostic significance of histopathological parameters in sentinel nodes of melanoma patients. Histopathology 2007;50:764–72PubMedCrossRef

Title: Criteria in Sentinel Lymph Nodes of Melanoma Patients that Predict Involvement of Nonsentinel Lymph Nodes
Authors: Imke Satzger
Bernward Völker
Andre Meier
Alexander Kapp
Ralf Gutzmer
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-9888-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Criteria in Sentinel Lymph Nodes of Melanoma Patients that Predict Involvement of Nonsentinel Lymph Nodes

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2008

Prophylactic Surgery in the Complex Decision-Making Management of BRCA Mutation Carriers

Radiofrequency Ablation of Invasive Breast Carcinomas: A Phase II Trial

HER2-Positive Early Breast Cancer and Trastuzumab: A Surgeon’s Perspective

Author Reply: Decision-Making Management of Women with a High Risk of Developing Breast and Ovarian Cancer

Long-term Survival and Occasional Regression of Distant Melanoma Metastases after Adrenal Metastasectomy

Clinicopathological Features and Surgical Outcomes of Patients with Remnant Gastric Cancer after a Distal Gastrectomy