Factors Predictive of Tumor-Positive Nonsentinel Lymph Nodes after Positive Sentinel Lymph Node Biopsy in Melanoma Patients: Westmead Melanoma Unit Experience and a Review of Literature (#186)
Approximately 20% of sentinel node (SN) positive melanoma patients have additional non-SN (NSN) metastasis. The aim for this study was to identify the factors associated with non-SN (NSN) metastasis, as a method to determine which patient cohort could probably be spared from the morbidity of CLND.
Methodology:Between 2000 and 2012, 50 patients (11 women and 39 men) underwent completion lymph node dissection (CLND) after positive sentinel lymph node biopsy. The clinicopathologic information was reviewed. Tumor load and tumor site were reclassified in all nodes by Rotterdam criteria. RESULTS:
Eleven (22%) patients had tumor-positive NSN. Median Breslow thickness was 3.00 mm. Univariate analyses showed that >50% proportion involved, regression, perinodal lymphatic invasion, maximum size of largest deposit, macrometastases>2mm were significantly associated with tumor-positive NSN. Age, sex, Breslow thickness, satellites, neurotropism, lymphovascular invasion, extranodal spread, ulceration, desmoplasia and histology were not predictive.CONCLUSION:
Size of the metastatic burden within the SLN, helps stratify the risk of harbouring residual disease in the nonsentinel lymph nodes (NSLN) may allow for selective CLND. However, further studies are needed to confirm the standard criteria for not performing CLND.