Top

Published in:

21-08-2022 | Ultrasound | Melanoma

Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound

Authors: Jennifer Keller, MD, Stacey Stern, PhD, Shu-Ching Chang, PhD, Rebecca Marcus, MD, Jessica Weiss, MD, Sean Nassoiy, DO, Wade Christopher, MD, Trevan Fischer, MD, Richard Essner, MD, FACS

Published in: Annals of Surgical Oncology | Issue 13/2022

Abstract

Background

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II) led to a change in the management of tumor-positive sentinel lymph nodes (SLNs) from completion node dissection (CLND) to nodal observation. This study aimed to evaluate prognostic factors for predicting sentinel node basin recurrence (SNBR) using data from MSLT-II trial participants.

Methods

In MSLT-II, 1076 patients were treated with observation. Patients were included in the current study if they had undergone a post-sentinel node basin ultrasound (PSNB-US) within 4 months after surgery. The study excluded patients with positive SLN by reverse transcription-polymerase chain reaction (RT-PCR) or incomplete SLN pathologic data. Primary tumor, patient, PSNB-US, and SLN characteristics were evaluated. Multivariable regression analyses were performed to determine independent prognostic factors associated with SNBR.

Results

The study enrolled 737 patients: 193 (26.2%) patients with SNBR and 73 (9.9%) patients with first abnormal US. The patients with an abnormal first US were more likely to experience SNBR (23.8 vs. 5.0%). In the multivariable analyses, increased risk of SNBR was associated with male gender (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.00–1.9; p = 0.049), increasing Breslow thickness (aHR, 1.10; 95% CI, 1.01–1.2; p = 0.038), presence of ulceration (aHR, 1.93; 95% CI, 1.42–2.6; p < 0.001), sentinel node tumor burden greater than 1 mm (aHR, 1.91; 95% CI, 1.10–3.3; p = 0.022), lymphovascular invasion (aHR, 1.53; 95% CI, 1.00–2.3; p = 0.048), and presence of abnormal PSNB-US (aHR, 4.29; 95% CI, 3.02–6.1; p < 0.001).

Conclusions

The first postoperative US together with clinical and pathologic factors may play an important role in predicting SNBR.

Available only for authorised users

Morton DL, Thompson JF, Cochran AJ, et al. Sentinel node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17. https://doi.org/10.1056/NEJMoa060992.CrossRefPubMed

Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel node metastasis in melanoma. N Engl J Med. 2017;376:2211–22. https://doi.org/10.1056/NEJMoa1613210.CrossRefPubMedPubMedCentral

Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17:757–67. https://doi.org/10.1016/S1470-2045(16)00141-8.CrossRefPubMed

Broman KK, Richman J, Bhatia S. Evidence and implementation gaps in management of sentinel node–positive melanoma in the United States. Surgery. 2022. https://doi.org/10.1016/j.surg.2021.12.025.CrossRefPubMed

Broman KK, Hughes TM, Bredbeck BC, et al. International center-level variation in utilization of completion lymph node dissection and adjuvant systemic therapy for sentinel lymph node-positive melanoma at major referral centers. Ann Surg. 2022. https://doi.org/10.1097/SLA.0000000000005370.CrossRefPubMed

Bredbeck BC, Mubarak E, Zubieta DG, et al. Management of the positive sentinel lymph node in the post-MSLT-II era. J Surg Oncol. 2020;122:1778–84. https://doi.org/10.1002/jso.26200.CrossRefPubMedPubMedCentral

Broman KK, Hughes T, Dossett L, et al. Active surveillance of patients who have sentinel node-positive melanoma: an international, multi-institution evaluation of adoption and early outcomes after the Multicenter Selective Lymphadenectomy Trial II (MSLT-2). Cancer. 2021;127:2251–61. https://doi.org/10.1002/cncr.33483.CrossRefPubMed

Melanoma Cutaneous (version 2.2022). National Comprehensive Cancer Network. Retrieved 17 Dec 2021 at https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf.

Voit C, Mayer T, Kron M, et al. Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients. Cancer. 2001;91:2409–16. https://doi.org/10.1002/1097-0142(20010615)91:12%3c2409::AID-CNCR1275%3e3.0.CO;2-S.CrossRefPubMed

10.

Blum A, Schlagenhauff B, Stroebel W, Breuninger H, Rassner G, Garbe C. Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma. Cancer. 2000;88:2534–9. https://doi.org/10.1002/1097-0142(20000601)88:11%3c2534::AID-CNCR15%3e3.0.CO;2-2.CrossRefPubMed

11.

Moehrle M, Blum A, Rassner G, Juenger M. Lymph node metastases of cutaneous melanoma: diagnosis by B-scan and color Doppler sonography. J Am Acad Dermatol. 1999;41:703–9. https://doi.org/10.1016/S0190-9622(99)70004-6.CrossRefPubMed

12.

Hayes AJ, Moskovic E, O’Meara K, et al. Prospective cohort study of ultrasound surveillance of regional lymph nodes in patients with intermediate-risk cutaneous melanoma. BJS Br J Surg. 2019;106:729–34. https://doi.org/10.1002/bjs.11112.CrossRef

13.

Krüger U, Kretschmer L, Thoms KM, et al. Lymph node ultrasound during melanoma follow-up significantly improves metastasis detection compared with clinical examination alone: a study on 433 patients. Melanoma Res. 2011;21:457–63. https://doi.org/10.1097/CMR.0b013e328348dad3.CrossRefPubMed

14.

Machet L, Nemeth-Normand F, Giraudeau B, et al. Is ultrasound lymph node examination superior to clinical examination in melanoma follow-up? A monocentre cohort study of 373 patients. Br J Dermatol. 2005;152:66–70. https://doi.org/10.1111/j.1365-2133.2004.06262.x.CrossRefPubMed

15.

Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378:1789–801. https://doi.org/10.1056/NEJMoa1802357.CrossRefPubMed

16.

Eggermont AMM, Chiarion-Sileni V, Grob JJ, et al. Prolonged survival in stage III melanoma with ipilimumab adjuvant therapy. N Engl J Med. 2016;375:1845–55. https://doi.org/10.1056/NEJMoa1611299.CrossRefPubMedPubMedCentral

17.

Long GV, Flaherty KT, Stroyakovskiy D, et al. Dabrafenib plus trametinib versus dabrafenib monotherapy in patients with metastatic BRAF V600E/K-mutant melanoma: long-term survival and safety analysis of a phase 3 study. Ann Oncol. 2017;28:1631–9. https://doi.org/10.1093/annonc/mdx176.CrossRefPubMedPubMedCentral

18.

Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377:1824–35. https://doi.org/10.1056/NEJMoa1709030.CrossRefPubMed

19.

Broman KK, Bettampadi D, Pérez-Morales J, et al. Surveillance of sentinel node-positive melanoma patients who receive adjuvant therapy without undergoing completion lymph node dissection. Ann Surg Oncol. 2021;28:6978–85. https://doi.org/10.1245/s10434-021-10570-5.CrossRefPubMedPubMedCentral

20.

Ho Shon IA, Chung DKV, Saw RPM, Thompson JF. Imaging in cutaneous melanoma. Nucl Med Commun. 2008;29:847–76. https://doi.org/10.1097/MNM.0b013e32830439fb.CrossRefPubMed

21.

Wong SL, Kattan MW, McMasters KM, Coit DG. A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American Joint Committee on Cancer staging system. Ann Surg Oncol. 2005;12:282–8. https://doi.org/10.1245/ASO.2005.05.016.CrossRefPubMed

22.

Lo SN, Ma J, Scolyer RA, et al. Improved risk prediction calculator for sentinel node positivity in patients with melanoma: the Melanoma Institute Australia Nomogram. J Clin Oncol. 2020;38:2719–27. https://doi.org/10.1200/JCO.19.02362.CrossRefPubMedPubMedCentral

Title: Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound
Authors: Jennifer Keller, MD
Stacey Stern, PhD
Shu-Ching Chang, PhD
Rebecca Marcus, MD
Jessica Weiss, MD
Sean Nassoiy, DO
Wade Christopher, MD
Trevan Fischer, MD
Richard Essner, MD, FACS
Publication date: 21-08-2022
Publisher: Springer International Publishing
Keywords: Ultrasound
Melanoma
Melanoma
Ultrasound
Published in: Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12345-y

At a glance: The STEP trials

Springer Medicine

Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2022

ASO Author Reflections: Is It Safe to Use Intrauterine Manipulators in Laparoscopic Surgery for Endometrial Cancer?

Expanding the Staging Criteria for T1-2N0 Hormone-Receptor Positive Breast Cancer Patients Enrolled in TAILORx

ASO Visual Abstract: ctDNA for Recurrence Risk Assessment in Patients Treated with Neoadjuvant Treatment—A Systematic Review and Meta-analysis

Pharmacologic Effects of Oxaliplatin Instability in Chloride-Containing Carrier Fluids on the Hyperthermic Intraperitoneal Chemotherapy to Treat Colorectal Cancer In Vitro and In Vivo

Clinical, Pathological Complete Response, and Prognosis Characteristics of HER2-Low Breast Cancer in the Neoadjuvant Chemotherapy Setting: A Retrospective Analysis

Appendiceal Incidentalomas: Prevalence, Radiographic Characteristics, Management, and Outcomes