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Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Most patients with melanoma have a thin (≤1.00 mm) lesion. There is uncertainty as to which patients with thin melanoma should undergo sentinel lymph node (SN) biopsy. We sought to quantify the proportion of SN metastases in patients with thin melanoma and to determine the pooled effect of high-risk features of the primary lesion on SN positivity.

Methods

Published literature between 1980 and 2015 was searched and critically appraised. Primary outcome was the proportion of SN metastases in patients with thin cutaneous melanoma. Secondary outcomes included the effect of high-risk pathological features of the primary lesion on the proportion of SN metastases. Summary measures were estimated by Mantel–Haenszel method using random effects meta-analyses.

Results

Sixty studies (10,928 patients) met the criteria for inclusion. Pooled SN positivity was 4.5 % [95 % confidence interval (CI) 3.8–5.2 %]. Predictors of a positive SN were: thickness ≥0.75 mm [adjusted odds ratio (AOR) 1.90 (95 % CI 1.08–3.34); with a likelihood of SN metastases of 8.8 % (95 % CI 6.4–11.2 %)]; Clark level IV/V [AOR 2.24 (95 % CI 1.23–4.08); with a likelihood of 7.3 % (95 % CI 6.2–8.4 %)]; ≥1 mitoses/mm2 [AOR 6.64 (95 % CI 2.77–15.88); pooled likelihood 8.8 % (95 % CI 6.2–11.4 %)]; and the presence of microsatellites [unadjusted OR 6.94 (95 % CI 2.13–22.60); likelihood 26.6 % (95 % CI 4.3–48.9 %)].

Conclusions

The pooled proportion of SN metastases in thin melanoma is 4.5 %. Thickness ≥0.75 mm, Clark level IV/V, mitoses, and microsatellites significantly increased the odds of SN positivity and should prompt strong consideration of SN biopsy.

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Acknowledgments

This work was supported in part by the Al Hertz Melanoma Research Grant. The study sponsor had no role in the design, collection, analysis, interpretation of the data, writing of the manuscript, or the decision to submit the manuscript. Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research by the Canadian Institute of Health Research. The authors thank Ms. Elizabeth Uleryk for her assistance with the literature search and Dr. Nathan Lamond for assistance with the manuscript.

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The authors have no relevant financial disclosures.

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Authors and Affiliations

  1. Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Erin Cordeiro MD, MSc, FRCSC

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Mai-Kim Gervais MD, FRCSC, Nicole J. Look Hong MD, MSc, FRCSC & Frances C. Wright MD, MEd, FRCSC

  3. Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah MD, MSc, FRCPC

  4. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah MD, MSc, FRCPC

  5. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Nicole J. Look Hong MD, MSc, FRCSC & Frances C. Wright MD, MEd, FRCSC

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  1. Erin Cordeiro MD, MSc, FRCSC
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Correspondence to Erin Cordeiro MD, MSc, FRCSC.

Appendix

Appendix

Erin Cordeiro, SLNBx in melanoma

May 31. 2015

Database: Ovid MEDLINE(R) < 1946 to May Week 1 2015>

Search Strategy:

  1. 2

    lymph node excision/or sentinel lymph node biopsy/

  2. 3

    (sentinel adj2 lymph adj2 node*).mp.

  3. 4

    exp Biopsy/

  4. 5

    Lymph Nodes/

  5. 6

    4 and 5 [****Lymph Node Biopsy Results previous indexing****]

  6. 7

    or/2-3,6 [****SLN results****]

  7. 8

    melanoma/or melanoma, amelanotic/or melanoma*.mp.

  8. 9

    Skin Neoplasms/

  9. 10

    ((cancer* or neoplas* or oncol*) adj2 (skin* or dermis or sun or cutaneous*)).mp.

  10. 11

    or/8-10 [****Melanoma or skin neoplasm results****]

  11. 12

    7 and 11 [****Base clinical set melanoma or general skin cancer****]

  12. 13

    cohort studies/or longitudinal studies/or follow-up studies/or prospective studies/

  13. 14

    case–control studies/or retrospective studies/or cross-sectional studies/

  14. 15

    prognosis/or disease-free survival/or medical futility/or pregnancy outcome/or treatment outcome/or treatment failure/

  15. 16

    disease progression/

  16. 17

    morbidity/or incidence/or prevalence/

  17. 18

    mortality/or cause of death/or fatal outcome/or hospital mortality/or infant mortality/or maternal mortality/or survival rate/

  18. 19

    survival analysis/or disease-free survival/or Kaplan–Meier estimate/or proportional hazards models/

  19. 20

    early diagnosis/

  20. 21

    natural histor???.tw.

  21. 22

    predictive value of tests/

  22. 23

    or/13-22 [****MEDLINE Prognosis Filter Sensitive****]

  23. 24

    evaluation studies.pt. or evaluation studies as topic/

  24. 25

    validation studies.pt. or validation studies as topic/

  25. 26

    “sensitivity and specificity”/or predictive value of tests/or roc curve/

  26. 27

    diagnostic errors/or false negative reactions/or false positive reactions/or observer variation/

  27. 28

    likelihood functions/

  28. 29

    (likelihood or likelihood ratio:).tw.

  29. 30

    predictive value of tests/

  30. 31

    di.fs.

  31. 32

    or/24-31 [****Diagnosis filter****]

  32. 33

    12 and 32 [****Diagnosis filter results****]

  33. 34

    12 and 23 [****Prognosis sensitive results****]

  34. 35

    34 not 33

  35. 36

    Mitosis/

  36. 37

    Mitotic Index/

  37. 38

    neoplasm invasiveness/or neoplasm metastasis/or lymphatic metastasis/or neoplasm micrometastasis/

  38. 39

    or/36-38 [****Specific outcomes****]

  39. 40

    12 and 39 [****Base clinical set specific oncology outcomes****]

  40. 41

    40 not (34 or 33) [****Unique outcome results****]

  41. 42

    33 or 34 or 40 [****Final results, diagnosis, prognosis or specific outcomes****]

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Cordeiro, E., Gervais, MK., Shah, P.S. et al. Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 23, 4178–4188 (2016). https://doi.org/10.1245/s10434-016-5137-z

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