Πέμπτη 16 Ιανουαρίου 2020

Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients.

2019 Sep;26(9):2855-2863. doi: 10.1245/s10434-019-07505-6. Epub 2019 Jun 25.

Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients.

Ipenburg NA1,2, Thompson JF3,4,5, Uren RF4,6, Chung D4,6, Nieweg OE3,4,5.

Author information

1: Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, Netherlands. n.a.ipenburg@lumc.nl.
2: Melanoma Institute Australia, Wollstonecraft, North Sydney, NSW, Australia. n.a.ipenburg@lumc.nl.
3: Melanoma Institute Australia, Wollstonecraft, North Sydney, NSW, Australia.
4: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
5: Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
6: Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Sydney, NSW, Australia.

Abstract

BACKGROUND:

Sentinel node (SN) biopsy (SNB) has become standard of care in clinically localized melanoma patients. Although it is minimally invasive, advanced age and/or comorbidities may render SNB inadvisable in some patients. Focused ultrasound follow-up of SNs identified by preoperative lymphoscintigraphy may be an alternative in these patients. This study examines the outcomes in patients managed in this way at a major melanoma treatment center.

METHODS:

All patients with clinically localized cutaneous melanoma who underwent lymphoscintigraphy and in whom SNB was intentionally not performed due to advanced age and/or comorbidities were included.

RESULTS:

Between 2000 and 2009, 160 patients (5.2% of the total) underwent lymphoscintigraphy without SNB because of advanced age and/or comorbidities. Compared with the 2945 patients who had a SNB, the 160 patients were older, had thicker melanomas that were more often located in the head and neck region, and had more SNs in more nodal regions. Of the 160 patients, 150 (94%) were followed with ultrasound examination of their SNs at each follow-up visit; this identified 33% of the nodal recurrences before they became clinically apparent. Compared with SN-positive patients who were treated by completion lymph node dissection, observed patients who developed nodal recurrence had more involved nodes when a delayed lymphadenectomy was performed. Melanoma-specific survival, recurrence-free survival, and distant recurrence-free survival rates were similar, while regional lymph node-free survival was worse.

CONCLUSIONS:

Lymphoscintigraphy with focused ultrasound follow-up of SNs is a reasonable management alternative to SNB in patients who are elderly and/or have substantial comorbidities.