Utility of a model for predicting the risk of sentinel lymph node metastasis in patients with cutaneous melanoma Journal Article
| Authors: | Marchetti, M. A.; Dusza, S. W.; Bartlett, E. K. |
| Article Title: | Utility of a model for predicting the risk of sentinel lymph node metastasis in patients with cutaneous melanoma |
| Abstract: | Importance: A neural network-based model (i31-GEP-SLNB) that uses clinicopathologic factors (thickness, mitoses, ulceration, patient age) plus molecular analysis (31-gene expression profiling) has become commercially available to guide selection for sentinel lymph node (SLN) biopsy in cutaneous melanoma, but its clinical utility is not well characterized. Objective: To determine if use of the i31-GEP-SLNB model is associated with clinical benefit when used to select patients for SLN biopsy. Design, Setting, and Participants: This decision-analytic study used data derived from a published external validation study of the i31-GEP-SLNB prediction model. Participants included patients with primary cutaneous melanoma. Main Outcomes and Measures: The primary outcome was the net benefit associated with using the i31-GEP-SLNB model for SLN biopsy selection compared with other selection strategies (SLN biopsy for all patients and SLN biopsy for no patients) at a 5% risk threshold. Analyses were stratified by American Joint Committee on Cancer (AJCC) T category. The reduction in the number of avoidable SLN biopsies and relative utility were also calculated. Results: Compared with other SLN biopsy selection strategies, use of the i31-GEP-SLNB model had greater net benefit for patients with T1b (+0.012), T2a (+0.002), and T2b melanoma (+0.002) but not for those with high-risk T1a (-0.003) disease. The improvement in relative utility was +22% in patients with T1b, +1% in T2a, and +2% in T2b melanoma. Compared with SLN biopsy for all patients, use of the model would equate to a 23% decrease in SLN biopsies among patients with T1b disease without an SLN metastasis with no increase in the number of patients with an SLN metastasis left untreated; among patients with T2a and T2b melanoma, the net decrease in avoidable biopsies compared with SLN biopsy for all was 3% and 4%, respectively. Conclusions and Relevance: The findings of this decision-analytic study suggest that i31-GEP SLNB has significant potential for risk-stratifying patients with T1b melanoma if using a 5% risk threshold; its role among patients with T1a and T2 melanoma or using other risk thresholds requires further study. A prospective validation study confirming the added clinical benefit and cost-effectiveness of i31-GEP-SLNB compared with free clinicopathologic-based prediction models is needed in patients with T1b melanoma.. © 2022 American Medical Association. All rights reserved. |
| Journal Title: | JAMA Dermatology |
| Volume: | 158 |
| Issue: | 6 |
| ISSN: | 2168-6068 |
| Publisher: | American Medical Association |
| Date Published: | 2022-06-01 |
| Start Page: | 680 |
| End Page: | 683 |
| Language: | English |
| DOI: | 10.1001/jamadermatol.2022.0970 |
| PUBMED: | 35475908 |
| PROVIDER: | scopus |
| PMCID: | PMC9047749 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 July 2022 -- Source: Scopus |
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