TY - JOUR
T1 - Completion lymph node dissection after a positive sentinel node
T2 - No longer a must?
AU - Van Der Ploeg, Augustinus P.T.
AU - Van Akkooi, Alexander C.J.
AU - Verhoef, Cornelis
AU - Eggermont, Alexander M.M.
PY - 2013/3
Y1 - 2013/3
N2 - Purpose of Review: Sentinel node biopsy (SNB) for primary melanoma is accepted worldwide as a diagnostic procedure. When sentinel node positive, the invasive completion lymph node dissection (CLND) is usually performed. Approximately 20% of CLND patients have nonsentinel node (NSN) metastases. The therapeutic benefit is unknown. This review analyzed the necessity of CLND in sentinel node positive patients. Recent Findings: Prognosis of sentinel node positive patients is highly heterogeneous. The Rotterdam and Dewar criteria and S-classification are important sentinel node tumor burden criteria to stratify melanoma patients for prognosis and risk of NSN metastases. Patients with less than 0.1Šmm metastases seem to have similar prognosis as sentinel node negative patients, especially when located in the subcapsular area. This depends on the use of an extensive sentinel node pathology protocol identifying possibly clinically irrelevant micrometastases. Summary: Consensus on the sentinel node pathology work-up and analysis protocols are crucial for correct risk stratification and for clinical decision-making. Primary and sentinel node tumor burden parameters and patient comorbidities should be taken into consideration when offering CLND to an individual patient. In the future, prospective studies such as the MSLT-II and the EORTC 1208 (Minitub) will provide answers to whether CLND has a therapeutic benefit and to which patients might safely be spared CLND.
AB - Purpose of Review: Sentinel node biopsy (SNB) for primary melanoma is accepted worldwide as a diagnostic procedure. When sentinel node positive, the invasive completion lymph node dissection (CLND) is usually performed. Approximately 20% of CLND patients have nonsentinel node (NSN) metastases. The therapeutic benefit is unknown. This review analyzed the necessity of CLND in sentinel node positive patients. Recent Findings: Prognosis of sentinel node positive patients is highly heterogeneous. The Rotterdam and Dewar criteria and S-classification are important sentinel node tumor burden criteria to stratify melanoma patients for prognosis and risk of NSN metastases. Patients with less than 0.1Šmm metastases seem to have similar prognosis as sentinel node negative patients, especially when located in the subcapsular area. This depends on the use of an extensive sentinel node pathology protocol identifying possibly clinically irrelevant micrometastases. Summary: Consensus on the sentinel node pathology work-up and analysis protocols are crucial for correct risk stratification and for clinical decision-making. Primary and sentinel node tumor burden parameters and patient comorbidities should be taken into consideration when offering CLND to an individual patient. In the future, prospective studies such as the MSLT-II and the EORTC 1208 (Minitub) will provide answers to whether CLND has a therapeutic benefit and to which patients might safely be spared CLND.
KW - completion lymph node dissection
KW - melanoma
KW - sentinel node
KW - tumor load
UR - http://www.scopus.com/inward/record.url?scp=84873735877&partnerID=8YFLogxK
U2 - 10.1097/CCO.0b013e32835dafb4
DO - 10.1097/CCO.0b013e32835dafb4
M3 - Review article
C2 - 23328628
AN - SCOPUS:84873735877
SN - 1040-8746
VL - 25
SP - 152
EP - 159
JO - Current Opinion in Oncology
JF - Current Opinion in Oncology
IS - 2
ER -