Sentinel lymph node biopsy for cutaneous melanoma - The Stanford experience, 1997-2004

被引:54
作者
Berk, DR
Johnson, DL
Uzieblo, A
Kiernan, M
Swetter, SM
机构
[1] Stanford Univ, Med Ctr, Dept Dermatol, Stanford, CA 94305 USA
[2] Stanford Univ, Med Ctr, Dept Surg, Stanford, CA 94305 USA
[3] Stanford Univ, Med Ctr, Dept Pathol, Stanford, CA 94305 USA
[4] Stanford Univ, Med Ctr, Stanford Prevent Res Ctr, Stanford, CA 94305 USA
[5] Vet Affairs Palo Alto Hlth Care Syst, Palo Alto, CA USA
关键词
D O I
10.1001/archderm.141.8.1016
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Objective: To review sentinel lymph node (SLN) data from Stanford University Medical Center from January 1, 1997, to January 1, 2004, including rates of SLN positivity according to 2002 American joint Committee on Cancer (AJCC) tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence. Design: Retrospective case series. Setting: Stanford University Medical Center and. Stanford melanoma clinics. Patients: A total of 274 consecutive patients with primary melanoma who under-went SLN biopsy (SLNB) between January 1, 1997, and January 1, 2004, or who were referred to the Stanford melanoma clinics after SLNB and were followed up through March 2005. Interventions: All patients underwent standard wide local excision of their primary tumors and SLNB with intradermal injection of isosulfan blue dye and/or technetium sulfur colloid. Main Outcome Measure: Rates of SLN positivity per 2002 AJCC tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence in node-negative and nodepositive patients. Results: positive SLNs were detected in 39 (15%) of 260 cases, including 0 (0%) of 45 for cutaneous melanomas 1.0 mm thick or less (T1), 21 (18%) of 115 for melanomas 1.01 to 2.0 mm thick (T2),12 (19%) of 64 for melanomas 2.01 to 4.0 mm thick (T3), and 5 (16%) of 32 for melanomas thicker than 4.0 mm (T4). Median Breslow depths were 1.89 mm for SLN-positive biopsy specimens and 1.50 mm for SLN-negative biopsy specimens (P=.07). The recurrence rate was 46% among SLN-positive patients, with a median time to recurrence of 8 months. Bivariate analysis revealed SLN positivity to be associated with AJCC tumor classification (P=.02), location on the trunk (P=.03), and presence of ulceration (P=.03). By multivariate logistic regression, ulceration (P=.01) was predictive of SLN positivity, whereas SLN status (P <.001), ulceration (P=.02), and location (P=.03) were predictive of recurrent disease. Conclusion: Data from the past 8 years confirm the accuracy and prognostic value of SLNB in cutaneous melanoma and the low rate of regional nodal recurrence for SLN-negative patients.
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页码:1016 / 1022
页数:7
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