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Pathologic examination of the sentinel lymph node in malignant melanoma
J L Messina1, L F Glass, C W Cruse
1University of South Florida College of Medicine, Cutaneous Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, USA.
The American Journal of Surgical Pathology
|June 12, 1999
Summary
Sentinel lymphadenectomy is crucial for melanoma staging. Detailed pathologic assessment, including immunohistochemistry, improves metastasis detection in sentinel lymph nodes, guiding patient treatment.
Area of Science:
- Pathology
- Oncology
- Surgical Oncology
Background:
- Sentinel lymphadenectomy is increasingly used for melanoma staging.
- Accurate assessment of sentinel lymph nodes is critical for patient management.
- Pathologists require standardized protocols for evaluating these specimens.
Purpose of the Study:
- To detail a standard pathology protocol for sentinel lymph node evaluation.
- To assess the effectiveness of immunohistochemistry in detecting melanoma metastases.
- To evaluate the utility of intraoperative touch preparation cytology.
Main Methods:
- Developed and implemented a protocol for complete tissue submission of sentinel lymph nodes.
- Routine use of S-100 protein immunohistochemical staining.
- Intraoperative touch preparation cytology for suspicious nodes.
Main Results:
- Examined 838 sentinel lymph nodes from 357 patients; 16% had metastases.
- Immunohistochemistry identified metastases missed by H&E staining in 45% of positive cases.
- Touch preparation cytology had 62% sensitivity with no false positives.
Conclusions:
- Thorough pathologic evaluation of sentinel lymph nodes is essential for melanoma staging.
- Complete tissue submission and routine immunohistochemistry are vital.
- Touch preparation cytology can be a useful adjunct in select cases.