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Published on: August 19, 2021
EORTC Melanoma Group sentinel node protocol identifies high rate of submicrometastases according to Rotterdam
Augustinus P T van der Ploeg1, Alexander C J van Akkooi, Paul I M Schmitz
1Department of Surgical Oncology, Erasmus University Medical Center, The Netherlands.
Abstract:
Sentinel node (SN) status is the most important prognostic factor for disease-free survival (DFS) and overall survival (OS) in stages I-II melanoma. We evaluated the positive sentinel node identification rate of the EORTC Melanoma Group (MG) protocol as well as its capacity to identify minimal tumour burden, according to the Rotterdam Criteria in 421 consecutive patients. Correlations between primary tumour characteristics and SN tumour burden were investigated. The same 2 pathologists worked up all SNs according to the EORTC MG protocol and tumour burden was scored according to the Rotterdam Criteria (<0.1 mm, 0.1-1.0 mm and >1.0 mm for the largest diameter of the largest metastasis in the SN). The positive SN detection rate was 28.7% with a false negative rate of 10.4% at a median Breslow thickness of 2.1 mm. The high positive identification rate of about 30% of the EORTC MG protocol has been confirmed in this study. The protocol is sensitive and identifies submicrometastases (<0.1 mm) in a high percentage (18%). The variables SN tumour load, non-SN (NSN) status and ulceration of the primary were independent prognostic factors for DFS and OS in the multivariate analysis. At a median follow-up time of 4.3 years patients with minimal tumour burden (<0.1 mm) had a 5 year OS rate of 91%, virtually identical to 90% for SN-negative patients. The NSN positivity rate of 0% in these patients indicates that they may be spared a completion lymph node dissection (CLND) and its morbidity.
Insights
The EORTC Melanoma Group (MG) protocol effectively identifies sentinel lymph node (SLN) metastases in melanoma patients. Minimal tumor burden in SLNs correlates with survival similar to SLN-negative patients, potentially avoiding completion lymph node dissection.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Sentinel node (SN) status is a critical prognostic factor for disease-free survival (DFS) and overall survival (OS) in early-stage melanoma.
- Accurate identification of SN involvement is crucial for treatment decisions and patient outcomes.
Purpose of the Study:
- To evaluate the EORTC Melanoma Group (MG) protocol's sentinel node (SN) identification rate.
- To assess the protocol's ability to detect minimal tumor burden using Rotterdam Criteria.
- To investigate correlations between primary tumor characteristics and SN tumor burden.
Main Methods:
- Analysis of 421 consecutive melanoma patients' SN status using the EORTC MG protocol.
- Pathological assessment of SNs by two dedicated pathologists.
- Tumor burden scoring according to Rotterdam Criteria (<0.1 mm, 0.1-1.0 mm, >1.0 mm).
Main Results:
- The positive SN detection rate was 28.7% with a 10.4% false-negative rate.
- The protocol identified submicrometastases (<0.1 mm) in 18% of cases.
- SN tumor load, non-SN (NSN) status, and primary tumor ulceration were independent prognostic factors for DFS and OS.
Conclusions:
- The EORTC MG protocol demonstrates a high positive identification rate and sensitivity for detecting minimal melanoma metastases in SNs.
- Patients with minimal SN tumor burden (<0.1 mm) exhibit survival rates comparable to SN-negative patients.
- These findings suggest that patients with minimal SN tumor burden may be candidates for avoiding completion lymph node dissection (CLND).
