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Intraoperative sentinel lymph node analysis in melanoma.

Brian D Badgwell1, Charles Pierce, J Ralph Broadwater

  • 1Department of Surgery, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. badgwell@uams.edu

Journal of Surgical Oncology
|December 18, 2010
PubMed
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Touch preparation cytology (TPC) and frozen section (FS) are sensitive and specific for intraoperative melanoma staging. These methods safely identify most sentinel lymph nodes with metastases, with 100% specificity.

Area of Science:

  • Oncology
  • Surgical Pathology
  • Dermatology

Background:

  • Melanoma staging requires accurate assessment of sentinel lymph nodes (SLN).
  • Intraoperative evaluation of SLN can guide surgical management.
  • Touch preparation cytology (TPC) and frozen section (FS) are rapid diagnostic techniques.

Purpose of the Study:

  • To evaluate the sensitivity and specificity of TPC and FS for intraoperative melanoma staging.
  • To compare the diagnostic accuracy of TPC and FS with permanent histology.
  • To assess the utility of these methods in guiding surgical decisions.

Main Methods:

  • Retrospective cohort study of 271 patients undergoing SLN biopsy for melanoma.
  • Intraoperative analysis using TPC and/or FS compared to permanent section H&E.

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  • Analysis included Diff-quick stain for TPC and H&E for FS and permanent sections.

    • Main Results:

    • Of 163 patients with intraoperative analysis, 33 had positive nodes on permanent histology.
    • Overall sensitivity for intraoperative methods was 61%; specificity was 100%.
    • Sensitivity varied by method: TPC alone (47%), FS alone (75%), and both TPC and FS (80%).

    Conclusions:

    • TPC and FS demonstrated high specificity (100%) with no false positives.
    • These methods can safely identify the majority of SLN harboring melanoma metastases.
    • Intraoperative TPC and FS are valuable tools for staging melanoma patients.