Sentinel Lymph Node Biopsy In Melanoma: A Single-surgeon, 1,000 Patient Experience
Daniela Duarte-Bateman, MD, Rebecca W. Knackstedt, MD, Brian R. Gastman, MD
Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH
Background
•The MSLT-I and DeCOG trials established the Sentinel Lymph Node Biopsy (SLNB) as the standard of care diagnostic, predictive and therapeutic tool in melanoma management.
•However, these trials did not include a representative head and neck patient cohort, which is important due to the high incidence of cervical and parotid lymph node metastasis in this region.
•The accuracy of SLNB has been examined, quantified, and improved. A wide range of false-negative rates (FNR) have been reported in the literature (ranging from 7% to 21%).
•To date, there is no “gold standard” technique for SLNB and outcomes rely heavily on surgeons’ relative experience.
•There is an unmet need to improve the accuracy of SLNB in melanoma management.
Methods
This is a single surgeon and single institution retrospective study using a prospectively held database. We evaluated the accuracy of the combination technique of gamma and indocyanine green (ICG) for SLN identification in patients with cutaneous melanoma.
•All melanoma patients who underwent SLNB by the senior author at Cleveland Clinic between February 2011 and December 2021 were included.
•Patients who lost follow up, with a follow up less than 3 months or with a non-cutaneous melanoma diagnosis were excluded.
•All nodes were assessed with standardized pathological evaluation.
Table 1. Demographics and Tumor Characteristics
Figure 1. SLNB using ICG fluorescence-based imaging
Melanoma Location Distribution
Positive slnb according to nodal site (%)
Table 2. SLNB results and Recurrence Rates
Conclusions
üThe combination technique of gamma and ICG is a reliable method for detecting nodal involvement in melanoma patients.
üThe head and neck subgroup, representing 25% of the cohort, exhibited similar outcomes with regard to recurrence and false negatives.
üThis is the largest reported cohort of melanoma patients to date, with the largest representation of head and neck cases.
üThe study's findings reveal one of the lowest false negative rates reported.
References
1.Morton, D. L., Thompson, J. F., Cochran, A. J., Mozzillo, N., Elashoff, R., Essner, R., ... & Wang, H. J. (2006). Sentinel-node biopsy or nodal observation in melanoma. New England Journal of Medicine, 355(13), 1307-1317.
2.Leiter, U., Stadler, R., Mauch, C., Hohenberger, W., Brockmeyer, N. H., Berking, C., Sunderkötter, C., Kaatz, M., Schatton, K., Lehmann, P., Vogt, T., Ulrich, J., Herbst, R., Gehring, W., Simon, J. C., Keim, U., Verver, D., Martus, P., Garbe, C., & German Dermatologic Cooperative Oncology Group (2019). Final Analysis of DeCOG-SLT Trial: No Survival Benefit for Complete Lymph Node Dissection in Patients With Melanoma With Positive Sentinel Node. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 37(32), 3000–3008. https://doi.org/10.1200/JCO.18.02306
3.Knackstedt R, Gastman BR. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma. Plast Reconstr Surg. 2021
4.Couto, R. et al. Determining the False-Negative Rate Using Fluorescence Image–Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma. Annals of Plastic Surgery. 2018
