Micromorphometric Features of Positive Sentinel Lymph Nodes Predict Involvement of Nonsentinel Nodes in Patients With Melanoma
| Autor: | Richard A. Scolyer, Jonathan R. Stretch, John F. Thompson, Stanley W. McCarthy, Raghwa Sharma, Ling-Xi L. Li, Helen M. Shaw |
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| Rok vydání: | 2004 |
| Předmět: | |
| Zdroj: | American Journal of Clinical Pathology. 122:532-539 |
| ISSN: | 1943-7722 0002-9173 |
| DOI: | 10.1309/tdwjtr15tdm1tg7q |
| Popis: | The aim of the present study was to determine whether micromorphometric features of positive sentinel lymph nodes (SLNs) from patients with melanoma are useful for predicting further nodal involvement in completion lymph node dissection (CLND) specimens. Of 986 patients with melanoma undergoing SLN biopsy between March 1992 and February 2001, 175 (17.7%) had at least 1 positive SLN and 140 had subsequent CLND specimens available for review. Further nodal involvement in CLND specimens was present in 24 (17.1%) of 140 patients. Of 8 micromorphometric features of the SLNs that were assessed, the presence of metastases in CLND specimens was correlated significantly with a tumor penetrative depth (maximum distance of melanoma cells from the inner margin of the SLN capsule) of more than 2 mm (P < .05), a deposit size of more than 10 mm 2 (P < .01), the presence of melanoma cells in perinodal lymphatic vessels (P < .01), and the effacement of nodal architecture by metastatic melanoma cells (P < .05). Our results indicate that some morphologic features of melanoma metastases in SLNs predict the likelihood of further nodal involvement in CLND specimens. Until the feasibility of sentinel lymph node (SLN) biopsy and its reliability as a staging procedure were established in the early 1990s, it was the policy of many large melanoma treatment centers worldwide to perform an elective lymph node dissection (ELND) of the relevant regional node field for patients with cutaneous melanomas more than 1.5 mm thick. 1 Because only about 20% of this group of patients had nodal involvement in regional node fields, the remaining 80% of patients undergoing ELNDs were placed unnecessarily at risk of anesthetic complications and surgical morbidity (including acute wound problems, nerve injury and chronic lymphedema). 2,3 It is now well established that SLN biopsy is a minimally invasive procedure that accurately indicates the regional node status of patients with melanoma. Indeed, it has proved to be the single most important prognostic factor for patients with early-stage melanoma. 3-6 Based on the finding of metastatic cells in SLNs, completion lymph node dissections (CLNDs) can now be performed only in selected patients with melanoma, while all other patients are spared this major and potentially morbid surgical procedure. However, among patients with positive SLNs, further nodal involvement in CLND specimens is identified in only 8% to 30% of cases. 7-9 If the pathologic features of patients’ positive SLNs could be used to predict who would not have further nodal involvement in a CLND specimen, these individuals also could be spared such major surgery and its inherent risks. Therefore, this study was performed with the aim of determining whether micromorphometric features of positive SLNs from patients with melanoma are useful for predicting which patients will and will not have further nodal involve |
| Databáze: | OpenAIRE |
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