Should we be imaging lymph nodes at initial diagnosis of early‐stage mycosis fungoides? Results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) international study*
Autor: | Hodak, E., Sherman, S., Papadavid, E., Bagot, M., Querfeld, C., Quaglino, P., Prince, H.M., Ortiz-Romero, P.L., Stadler, R., Knobler, R., Guenova, E., Estrach, T., Patsatsi, A., Leshem, Y.A., Prague-Naveh, H., Berti, E., Alberti-Violetti, S., Cowan, R., Jonak, C., Nikolaou, V., Mitteldorf, C., Akilov, O., Geskin, L., Matin, R., Beylot-Barry, M., Vakeva, L., Sanches, J.A., Servitje, O., Weatherhead, S., Wobser, M., Yoo, J., Bayne, M., Bates, A., Dunnill, G., Marschalko, M., Buschots, A.M., Wehkamp, U., Evison, F., Hong, E., Amitay-Laish, I., Stranzenbach, R., Vermeer, M., Willemze, R., Kempf, W., Cerroni, L., Whittaker, S., Kim, Y.H., Scarisbrick, J.J., Cutaneous Lymphoma Int Consortium |
---|---|
Přispěvatelé: | HUS Inflammation Center, Clinicum, Helsinki University Hospital Area |
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Skin Neoplasms EUROPEAN-ORGANIZATION SOCIETY Physical examination Dermatology GUIDELINES CLASSIFICATION Cutaneous lymphoma Cutaneous patch 030207 dermatology & venereal diseases 03 medical and health sciences Mycosis Fungoides 0302 clinical medicine International Prognostic Index Biopsy SEZARY-SYNDROME medicine Humans COMPUTED-TOMOGRAPHY Prospective Studies Stage (cooking) RESPONSE CRITERIA Neoplasm Staging Body surface area Mycosis fungoides medicine.diagnostic_test business.industry CONSORTIUM Prognosis medicine.disease 3121 General medicine internal medicine and other clinical medicine SURVIVAL Lymph Nodes Radiology business TASK-FORCE |
Zdroj: | British Journal of Dermatology, 184(3), 524-531. WILEY |
ISSN: | 1365-2133 0007-0963 |
Popis: | Background Early-stage mycosis fungoides (MF) includes involvement of dermatopathic lymph nodes (LNs) or early lymphomatous LNs. There is a lack of unanimity among current guidelines regarding the indications for initial staging imaging in early-stage presentation of MF in the absence of enlarged palpable LNs. Objectives To investigate how often imaging is performed in patients with early-stage presentation of MF, to assess the yield of LN imaging, and to determine what disease characteristics promoted imaging. Methods A review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) data. Results PROCLIPI enrolled 375 patients with stage T1/T2 MF: 304 with classical MF and 71 with folliculotropic MF. Imaging was performed in 169 patients (45%): 83 with computed tomography, 18 with positron emission tomography-computed tomography and 68 with ultrasound. Only nine of these (5%) had palpable enlarged (>= 15 mm) LNs, with an over-representation of plaques, irrespectively of the 10% body surface area cutoff that distinguishes T1 from T2. Folliculotropic MF was not more frequently imaged than classical MF. Radiologically enlarged LNs (>= 15 mm) were detected in 30 patients (18%); only seven had clinical lymphadenopathy. On multivariate analysis, plaque presentation was the sole parameter significantly associated with radiologically enlarged LNs. Imaging of only clinically enlarged LNs upstaged 4% of patients (seven of 169) to at least IIA, whereas nonselective imaging upstaged another 14% (24 of 169). LN biopsy, performed in eight of 30 patients, identified N3 (extensive lymphomatous involvement) in two and N1 (dermatopathic changes) in six. Conclusions Physical examination was a poor determinant of LN enlargement or involvement. Presence of plaques was associated with a significant increase in identification of enlarged or involved LNs in patients with early-stage presentation of MF, which may be important when deciding who to image. Imaging increases the detection rate of stage IIA MF, and identifies rare cases of extensive lymphomatous nodes, upstaging them to advanced-stage IVA2. |
Databáze: | OpenAIRE |
Externí odkaz: |