España MI, Signorini F, Marani M, Alcaraz A, Reimondez S, Romero ME, Obeide L

Language: Spanish
References: 25
Page: 241-246
PDF size: 249.10 Kb.

ABSTRACT

Introduction: The study of the Sentinel Lymph Node (SLN) in Melanoma is a procedure that aims the identification of the first node to which the affected cutaneous sector drains in order to avoid unnecessary lymphadenectomies. The present study documents the frequency of identification of SLN; the relationship between positive SLN (PSLN) and recurrence, between the Breslow index (BI) and PSLN, and between BI and disease recurrence. Method: We analyzed the records of 148 patients with melanoma stages I and II undergoing lymphatic mapping and GC biopsy from 1999 to 2017 in a third level institution in Córdoba, Argentina. We performed preoperative lympho centellography, lymphatic mapping with combined technique and SLN biopsy. Postoperative controls were established in order to detect recurrences. Results: SLN was identified in 145 patients (97.9%), being positive in 25 cases (17.2%). Recurrence was detected in 10 (8.3%) patients with negative SLN (NSLN), and in 2 (9.09%) with PSLN (p = 0.188). The median BI was 2 mm in PCG patients and 1.2 mm in GCN patients (p = 0.002). The mean BI in patients with recurrence was 2.77 mm, and 2.01 mm in those who did not show relapse (p = 0.311). Conclusions: The combined technique allows a high GC identification rate. A greater tendency to recurrence was observed in the presence of CPG. A statistically significant relationship between GCP and IB was found. The GC technique is effective and replicable in our environment.

REFERENCES

1. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004;54:8-29.

2. Bleicher RJ, Essner R, Foshag LJ, Wanek LA, Morton DL. Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol. 2003;21:1326-31.

3. Li L-XL, Scolyer RA, Ka VSK, McKinnon JG, Shaw HM, McCarthy SW, et al. Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence: a clinicopathologic study of 1152 patients undergoing sentinel lymph node biopsy. Am J Surg Pathol. 2003;27:1197-202.

4. Mangas C, Paradelo C, Puig S, Gallardo F, Marcoval J, Azon A, et al. [Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. Actas Dermosifiliogr. 2010;101:129-42.

5. Garbe C, Eigentler TK. Diagnosis and treatment of cutaneous melanoma: state of the art 2006. Melanoma Res. 2007;17:117-27.

6. Gould EA, Winship T, Philbin PH, Kerr HH. Observations on a “sentinel node” in cancer of the parotid. Cancer. 1960;13:77-8.

7. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39:456-66.

8. Morton DL. Current management of malignant melanoma. Ann Surg. 1990;212:123-4.

9. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392-9.

10. Cochran AJ, Wen DR, Morton DL. Management of the regional lymph nodes in patients with cutaneous malignant melanoma. World J Surg. 1992;16:214-21.

11. Gershenwald JE, Colome MI, Lee JE, Mansfield PF, Tseng C, Lee JJ, 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.

12. Thompson JF, McCarthy WH, Bosch CM, O'Brien CJ, Quinn MJ, Paramaesvaran S, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res. 1995;5:255-60.

13. Albertini JJ, Cruse CW, Rapaport D, Wells K, Ross M, DeConti R, et al. Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanoma. Ann Surg. 1996; 223:217-24.

14. Krag DN, Meijer SJ, Weaver DL, Loggie BW, Harlow SP, Tanabe KK, et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg. 1995;130:654-60.

15. Alex JC, Weaver DL, Fairbank JT, Rankin BS, Krag DN. Gamma-probe- guided lymph node localization in malignant melanoma. Surg Oncol. 1993;2:303-8.

16. Bostick P, Essner R, Glass E, Kelley M, Sarantou T, Foshag LJ, et al. Comparison of blue dye and probe-assisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins. Arch Surg. 1999;134:43-9.

17. Carlson GW, Murray DR, Lyles RH, Staley CA, Hestley A, Cohen C. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol. 2003;10:575-81.

18. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599-609.

19. Yu LL, Flotte TJ, Tanabe KK, Gadd MA, Cosimi AB, Sober AJ, et al. Detection of microscopic melanoma metastases in sentinel lymph nodes. Cancer. 1999;86:617-27.

20. Milton GW, Shaw HM, McCarthy WH, Pearson L, Balch CM, Soong SJ. Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: results of surgical treatment in 1319 patients. Br J Surg. 1982;69:108-11.

21. Clary BM, Brady MS, Lewis JJ, Coit DG. 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.

22. Shivers SC, Wang X, Li W, Joseph E, Messina J, Glass LF, et al. Molecular staging of malignant melanoma: correlation with clinical outcome. JAMA. 1998;280:1410-5.

23. Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004;351:998-1012.

24. Balch CM, Soong SJ, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979;86:343-51.

25. Ramnath, Kamath, Brobeil, Stall A, Kamath V V, Cruse CW, et al. Lymphatic mapping for melanoma: long-term results of regional nodal sampling with radioguided surgery. Cancer Control. 1997;4:483-90.