Top

Published in:

01-03-2010 | Melanomas

Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients

Authors: Charles R. Scoggins, MD, MBA, Robert C. G. Martin, MD, PhD, Merrick I. Ross, MD, Michael J. Edwards, MD, Douglas S. Reintgen, MD, Marshall M. Urist, MD, Jeffrey E. Gershenwald, MD, Jeffrey J. Sussman, MD, R. Dirk Noyes, MD, James S. Goydos, MD, Peter D. Beitsch, MD, Stephan Ariyan, MD, Arnold J. Stromberg, PhD, Lee J. Hagendoorn, MBA, Kelly M. McMasters, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2010

Abstract

Introduction

Some melanoma patients who undergo sentinel lymph node (SLN) biopsy will have false-negative (FN) results. We sought to determine the factors and outcomes associated with FN SLN biopsy.

Methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma of thickness > 1.0 mm who underwent SLN biopsy. FN results were defined as the proportion of node-positive patients who had a tumor-negative sentinel node biopsy. Kaplan–Meier survival analysis and univariate and multivariate analyses were performed.

Results

This analysis included 2,451 patients with median follow-up of 61 months. FN, true-positive (TP), and true-negative (TN) SLN results were found in 59 (10.8%), 486 (19.8%), and 1,906 (77.8%) patients, respectively. On univariate analysis comparing the FN with TP groups, respectively, the following factors were significantly different: age (52.6 vs. 47.6 years, p = 0.004), thickness (mean 2.1 vs. 3.1 mm, p = 0.003), lymphovascular invasion (LVI; 3.7 vs. 13.7%, p = 0.037), and local/in-transit recurrence (LITR; 32.2 vs. 12.4%, p < 0.0001); these factors remained significant on multivariate analysis. Overall 5-year survival was greater in the TN group (86.7%) compared with the TP (62.3%) and FN (51.3%) groups (p < 0.0001); however, there was no significant difference in overall survival comparing the TP and FN groups (p = 0.32).

Conclusions

This is the largest study to evaluate FN SLN results in melanoma, with a FN rate of 10.8%. FN results are associated with greater patient age, lower mean thickness, less frequent LVI, and greater risk of LITR. However, survival of patients with FN SLN is not statistically worse than that of patients with TP SLN.

American Cancer Society. Cancer Facts and Figures, 2007. 2007.

Chao C, Wong SL, Edwards MJ, et al. Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol. 2003;10:21–6.CrossRefPubMed

Chao C, Martin RC, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11:259–264.CrossRefPubMed

McMasters KM. Multiple nodal basin drainage in truncal melanomas. Ann Surg Oncol. 2000;7:249–250.CrossRefPubMed

McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol. 2004;86:212–23.CrossRefPubMed

Scoggins CR, Ross MI, Reintgen DS, et al. Gender-related differences in outcome for melanoma patients. Ann Surg. 2006;243:693–698.CrossRefPubMed

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;19:3622–3634.PubMed

Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. 1992;8:400–14.CrossRefPubMed

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;17:976–83.PubMed

10.

Thomas JM, Patocskai EJ. The argument against sentinel node biopsy for malignant melanoma. BMJ. 2000;321:3–4.CrossRefPubMed

11.

Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23.CrossRefPubMed

12.

Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242:302–11.PubMed

13.

Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol. 1998;16:2253–60.PubMed

14.

Leong SP, Kashani-Sabet M, Desmond RA, et al. Clinical significance of occult metastatic melanoma in sentinel lymph nodes and other high-risk factors based on long-term follow-up. World J Surg. 2005;29:683–691.CrossRefPubMed

15.

Cochran AJ, Morton DL. Detection of clinically relevant melanoma metastases requires focused, not exhaustive, evaluation of sentinel lymph nodes. Am J Surg Pathol. 2006;30:419–20.PubMed

16.

McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–7.CrossRefPubMed

17.

McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer–not yet the standard of care. N Engl J Med. 1998;339:990–5.CrossRefPubMed

18.

Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg. 2000;87:484–489.CrossRefPubMed

19.

Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71.CrossRefPubMed

20.

Carlson GW, Page AJ, Cohen C, et al. Regional recurrence after negative sentinel lymph node biopsy for melanoma. Ann Surg. 2008;248:378–386.PubMed

21.

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

22.

Clary BM, Brady MS, Lewis JJ, et al. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg. 2001;233:250–8.CrossRefPubMed

23.

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;12:429–39.CrossRefPubMed

24.

Statius Muller MG, van Leeuwen PA, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with stage I or II cutaneous melanoma. Cancer. 2001;91:2401–8.CrossRefPubMed

25.

Conway WC, Faries MB, Nicholl MB, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16:1548–52.CrossRefPubMed

26.

Karim RZ, Scolyer RA, Li W, et al. False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology. Ann Surg. 2008;247:1003–10.CrossRefPubMed

27.

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

28.

Riber-Hansen R, Sjoegren P, Hamilton-Dutoit SJ, et al. Extensive pathological analysis of selected melanoma sentinel lymph nodes: high metastasis detection rates at reduced workload. Ann Surg Oncol. 2008;15:1492–501.CrossRefPubMed

29.

Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4.CrossRefPubMed

30.

Kretschmer L, Beckmann I, Thoms KM, et al. Factors predicting the risk of in-transit recurrence after sentinel lymphonodectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol. 2006;13:1105–12.CrossRefPubMed

31.

Kang JC, Wanek LA, Essner R, et al. Sentinel lymphadenectomy does not increase the incidence of in-transit metastases in primary melanoma. J Clin Oncol. 2005;23:4764–70.CrossRefPubMed

32.

Kretschmer L, Beckmann I, Thoms KM, et al. Sentinel lymphonodectomy does not increase the risk of loco-regional cutaneous metastases of malignant melanomas. Eur J Cancer. 2005;41:531–8.CrossRefPubMed

33.

Nowecki ZI, Rutkowski P, Nasierowska-Guttmejer A, et al. Survival analysis and clinicopathological factors associated with false-negative sentinel lymph node biopsy findings in patients with cutaneous melanoma. Ann Surg Oncol. 2006;13:1655–63.CrossRefPubMed

34.

Caraco C, Marone U, Celentano E, et al. Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14:2662–7.CrossRefPubMed

Title: Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients
Authors: Charles R. Scoggins, MD, MBA
Robert C. G. Martin, MD, PhD
Merrick I. Ross, MD
Michael J. Edwards, MD
Douglas S. Reintgen, MD
Marshall M. Urist, MD
Jeffrey E. Gershenwald, MD
Jeffrey J. Sussman, MD
R. Dirk Noyes, MD
James S. Goydos, MD
Peter D. Beitsch, MD
Stephan Ariyan, MD
Arnold J. Stromberg, PhD
Lee J. Hagendoorn, MBA
Kelly M. McMasters, MD, PhD
Publication date: 01-03-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0858-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2010

The Marriage Between Pathology and Genetics: Are We Ready for Clinical Use?

Computer-Based Learning Module and the Educational Process for Women with Breast Cancer Who Desire Reconstruction

The Value of Intraoperative Parathyroid Hormone Monitoring in Localized Primary Hyperparathyroidism: A Cost Analysis

Avoiding Axillary Treatment in Sentinel Lymph Node Micrometastases of Breast Cancer: A Prospective Analysis of Axillary or Distant Recurrence

Feasibility of a Novel Approach to Inguinal Lymphadenectomy: Minimally Invasive Groin Dissection for Melanoma

Who Is to Blame for False-Negative Sentinel Node Biopsies in Melanoma?