Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy Journal Article

  

Authors:	Gold, J. S.; Jaques, D. P.; Busam, K. J.; Brady, M. S.; Coit, D. G.
Article Title:	Yield and predictors of radiologic studies for identifying distant metastases in melanoma patients with a positive sentinel lymph node biopsy
Abstract:	Background: It is common to obtain radiological studies around the time of a positive sentinel lymph node biopsy (SLNB) to exclude patients with distant metastases from completion lymph node dissection. The yield of such a work-up is unknown. Methods: Patients were identified from a prospectively maintained database. Medical records were reviewed. Results: Over an 8-year period, 181 patients had a positive SLNB. At least one study (computed tomography or magnetic resonance imaging of the brain; chest x-ray; computed tomography of the thorax, abdomen, or pelvis; positron-emission tomography scan; or bone scan) was obtained around the time of SLNB in 178 patients (98%). Studies were obtained after SLNB in 107 patients (59%). Studies ordered after SLNB resulted in indeterminate findings in 51 patients (48% of those studied). Among patients tested after SLNB, four were found to have metastatic disease (positive rate 3.7%). All of these patients had both a thick melanoma and macrometastasis within the SLN. The number of patients with indeterminate findings would be decreased and the yield of the work-up increased by 4 fold, by restricting the work-up to those with thick melanoma and macrometastasis. Conclusions: Radiological studies obtained after a positive SLN produce indeterminate findings in about half of the patients and identify distant disease in 3.7%. Restricting work-up to patients with thick melanoma and macrometastasis on SLNB would spare patients from indeterminate findings and increase the yield of the evaluation. © 2007 Society of Surgical Oncology.
Keywords:	adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; survival analysis; major clinical study; histopathology; review; neuroimaging; nuclear magnetic resonance imaging; positron emission tomography; lymph node metastasis; lymph node dissection; pelvis; sentinel lymph node; sentinel lymph node biopsy; melanoma; metastasis; computer assisted tomography; skin neoplasms; data base; statistical analysis; abdomen; radiology; positron-emission tomography; neoplasm metastasis; prediction and forecasting; micrometastasis; thorax radiography; bone scintiscanning; computed tomography; thorax; databases
Journal Title:	Annals of Surgical Oncology
Volume:	14
Issue:	7
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2007-07-01
Start Page:	2133
End Page:	2140
Language:	English
DOI:	10.1245/s10434-007-9399-3
PUBMED:	17453294
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-34250898568&partnerID=40&md5=3049583a08c22344b3fa476e253fb906
Notes:	--- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus"

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