Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-1, an international multicenter trial.

نویسنده

  • Patrick Twomey
چکیده

OBJECTIVE The objective of this study was to evaluate, in an international multicenter phase III trial, the accuracy, use, and morbidity of intraoperative lymphatic mapping and sentinel node biopsy (LM/SNB) for staging the regional nodal basin of patients with early-stage melanoma. SUMMARY BACKGROUND DATA Since our introduction of LM/SNB in 1990, this technique has been widely adopted and has become part of the American Joint Committee on Cancer (AJCC) staging system. Eleven years ago, the authors began the international Multicenter Selective Lymphadenectomy Trial (MSLT-I) to compare 2 treatment approaches: wide excision (WE) plus LM/SNB with immediate complete lymphadenectomy (CLND) for sentinel node (SN) metastases, and WE plus postoperative observation with CLND delayed until the subsequent development of clinically evident nodal metastases. METHODS After each center achieved 85% accuracy of SN identification during a 30-case learning phase, patients with primary cutaneous melanoma (> or =1 mm with Clark level > or =III, or any thickness with Clark level > or =IV) were randomly assigned in a 4:6 ratio to WE plus observation (WEO) with delayed CLND for nodal recurrence, or to WE plus LM/SNB with immediate CLND for SN metastasis. The accuracy of LM/SNB was determined by comparing the rates of SN identification and the incidence of SN metastases in the LM/SNB group versus the subsequent development of nodal metastases in the regional nodal basin of those patients with tumor-negative SNs. Early morbidity of LM/SNB was evaluated by comparing complication rates between the 2 treatment groups. Trial accrual was completed on March 31, 2002, after enrollment of 2001 patients. RESULTS Initial SN identification rate was 95.3% overall: 99.3% for the groin, 95.3% for the axilla, and 84.5% for the neck basins. The rate of false-negative LM/SNB during the trial phase, as measured by nodal recurrence in a tumor-negative dissected SN basin, decreased with increasing case volume at each center: 10.3% for the first 25 cases versus 5.2% after 25 cases. There were no operative mortalities. The low (10.1%) complication rate after LM/SNB increased to 37.2% with the addition of CLND; CLND also increased the severity of complications. CONCLUSIONS LM/SNB is a safe, low-morbidity procedure for staging the regional nodal basin in early melanoma. Even after a 30-case learning phase and 25 additional LM/SNB cases, the accuracy of LM/SNB continues to increase with a center's experience. LM/SNB should become standard care for staging the regional lymph nodes of patients with primary cutaneous melanoma.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Sentinel lymph node biopsy and melanoma biology.

Minimally invasive intraoperative lymphatic mapping and sentinel node biopsy has become the standard approach for staging the regional lymph nodes for early-stage melanoma. The procedure requires close collaboration of surgeon, pathologist, and nuclear medicine physician. The strength of lymphatic mapping and sentinel node biopsy is its accuracy of detecting occult lymph node metastases. Revers...

متن کامل

Response to: Routine usage of sentinel node biopsy in melanoma management must cease.

Sentinel lymph node biopsy (SNB) was first popularized in the 1990s because it might save lives. The multicenter selective lymphadenectomy trial (MSLT) demonstrated that SNB and subsequent completion lymphadenectomy (CL) do not improve either five year or ten year melanoma specific survival. SNB is expensive and can affect ongoing quality of life. Complication rates of 10% can include anaphylax...

متن کامل

Sentinel lymph node biopsy in melanoma patients: An experience with Tc-99m antimony sulfide colloid

  Introduction: Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Methods: Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony...

متن کامل

Sentinel lymph node biopsy correctly predicts regional lymph node recurrence in trunk malignant melanoma with multiple drainage basins

We report a young male with an initial excisional biopsy report of melanoma of the lower back, referred to our hospital for complete excision and sentinel lymph node (SLN) biopsy.  Four peritumoral intradermal Tc-99m phytate injection was performed and SLNs were detected in both axillary and right inguinal regions. On the biopsy only the right axillary SLN was metastatic leading to right axilla...

متن کامل

The need for skin pen marking for sentinel lymph node biopsy: A comparative study

  Introduction: There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage (I and II) breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. Methods: 40 ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Annals of surgery

دوره 242 3  شماره 

صفحات  -

تاریخ انتشار 2005