Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma: Therapeutic Utility and Implications of Nodal Microanatomy and Molecular Staging for Improving the Accuracy of Detection of Nodal Micrometastases

Donald L. Morton, Dave S B Hoon, Alistair J. Cochran, Roderick R. Turner, Richard Essner, Hiroya Takeuchi, Leslie A. Wanek, Edwin Glass, Leland J. Foshag, Eddy C. Hsueh, Anton J. Bilchik, David Elashoff, Robert Elashoff, Charles M. Balch

Research output: Contribution to journalArticle

Abstract

Objective: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been applied to virtually all solid neoplasms since our original description of LM/SL for melanoma. Our objectives were to determine the diagnostic and therapeutic utility of LM/SL, investigate carbon dye for mapping the microanatomy of lymphatic flow within the sentinel node (SN), and determine the prognostic accuracy of molecular assessment of the SN. Methods: Since 1985, 1599 patients with AJCC Stage I/II melanoma have been treated by LM/SL at our institution and 4590 have been treated by wide excision (WE) without nodal staging. We examined the incidence of clinical nodal recurrence after WE alone, the incidence of subclinical nodal metastases found by LM/SL, and the incidence of nodal recurrence in basins with histopathology-negative SNs. Results: In 1514 LM/SL patients with a primary of known Breslow thickness, the incidence of metastasis in nodes claimed to be sentinel was 7.3%, 19.7%, 33.2%, and 39.7% for primary lesions ≤1.0, 1.01-2.0, 2.01-4.0, and >4.0 mm, respectively. In 3652 WE-only patients, the corresponding rates of nodal recurrence were 12.0%, 32.0%, 34.4%, and 30.1%. Thus, LM/SL detected only 60% of expected nodal metastases from primary melanomas

Original languageEnglish (US)
Pages (from-to)538-550
Number of pages13
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Neoplasm Micrometastasis
Lymph Node Excision
Melanoma
Therapeutics
Incidence
Recurrence
cyhalothrin
Neoplasm Metastasis
Lymphatic Metastasis
Coloring Agents
Carbon

ASJC Scopus subject areas

  • Surgery

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Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma : Therapeutic Utility and Implications of Nodal Microanatomy and Molecular Staging for Improving the Accuracy of Detection of Nodal Micrometastases. / Morton, Donald L.; Hoon, Dave S B; Cochran, Alistair J.; Turner, Roderick R.; Essner, Richard; Takeuchi, Hiroya; Wanek, Leslie A.; Glass, Edwin; Foshag, Leland J.; Hsueh, Eddy C.; Bilchik, Anton J.; Elashoff, David; Elashoff, Robert; Balch, Charles M.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 538-550.

Research output: Contribution to journalArticle

Morton, DL, Hoon, DSB, Cochran, AJ, Turner, RR, Essner, R, Takeuchi, H, Wanek, LA, Glass, E, Foshag, LJ, Hsueh, EC, Bilchik, AJ, Elashoff, D, Elashoff, R & Balch, CM 2003, 'Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma: Therapeutic Utility and Implications of Nodal Microanatomy and Molecular Staging for Improving the Accuracy of Detection of Nodal Micrometastases', Annals of Surgery, vol. 238, no. 4, pp. 538-550.
Morton, Donald L. ; Hoon, Dave S B ; Cochran, Alistair J. ; Turner, Roderick R. ; Essner, Richard ; Takeuchi, Hiroya ; Wanek, Leslie A. ; Glass, Edwin ; Foshag, Leland J. ; Hsueh, Eddy C. ; Bilchik, Anton J. ; Elashoff, David ; Elashoff, Robert ; Balch, Charles M. / Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma : Therapeutic Utility and Implications of Nodal Microanatomy and Molecular Staging for Improving the Accuracy of Detection of Nodal Micrometastases. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 538-550.
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abstract = "Objective: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been applied to virtually all solid neoplasms since our original description of LM/SL for melanoma. Our objectives were to determine the diagnostic and therapeutic utility of LM/SL, investigate carbon dye for mapping the microanatomy of lymphatic flow within the sentinel node (SN), and determine the prognostic accuracy of molecular assessment of the SN. Methods: Since 1985, 1599 patients with AJCC Stage I/II melanoma have been treated by LM/SL at our institution and 4590 have been treated by wide excision (WE) without nodal staging. We examined the incidence of clinical nodal recurrence after WE alone, the incidence of subclinical nodal metastases found by LM/SL, and the incidence of nodal recurrence in basins with histopathology-negative SNs. Results: In 1514 LM/SL patients with a primary of known Breslow thickness, the incidence of metastasis in nodes claimed to be sentinel was 7.3{\%}, 19.7{\%}, 33.2{\%}, and 39.7{\%} for primary lesions ≤1.0, 1.01-2.0, 2.01-4.0, and >4.0 mm, respectively. In 3652 WE-only patients, the corresponding rates of nodal recurrence were 12.0{\%}, 32.0{\%}, 34.4{\%}, and 30.1{\%}. Thus, LM/SL detected only 60{\%} of expected nodal metastases from primary melanomas",
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T2 - Therapeutic Utility and Implications of Nodal Microanatomy and Molecular Staging for Improving the Accuracy of Detection of Nodal Micrometastases

AU - Morton, Donald L.

AU - Hoon, Dave S B

AU - Cochran, Alistair J.

AU - Turner, Roderick R.

AU - Essner, Richard

AU - Takeuchi, Hiroya

AU - Wanek, Leslie A.

AU - Glass, Edwin

AU - Foshag, Leland J.

AU - Hsueh, Eddy C.

AU - Bilchik, Anton J.

AU - Elashoff, David

AU - Elashoff, Robert

AU - Balch, Charles M.

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N2 - Objective: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been applied to virtually all solid neoplasms since our original description of LM/SL for melanoma. Our objectives were to determine the diagnostic and therapeutic utility of LM/SL, investigate carbon dye for mapping the microanatomy of lymphatic flow within the sentinel node (SN), and determine the prognostic accuracy of molecular assessment of the SN. Methods: Since 1985, 1599 patients with AJCC Stage I/II melanoma have been treated by LM/SL at our institution and 4590 have been treated by wide excision (WE) without nodal staging. We examined the incidence of clinical nodal recurrence after WE alone, the incidence of subclinical nodal metastases found by LM/SL, and the incidence of nodal recurrence in basins with histopathology-negative SNs. Results: In 1514 LM/SL patients with a primary of known Breslow thickness, the incidence of metastasis in nodes claimed to be sentinel was 7.3%, 19.7%, 33.2%, and 39.7% for primary lesions ≤1.0, 1.01-2.0, 2.01-4.0, and >4.0 mm, respectively. In 3652 WE-only patients, the corresponding rates of nodal recurrence were 12.0%, 32.0%, 34.4%, and 30.1%. Thus, LM/SL detected only 60% of expected nodal metastases from primary melanomas

AB - Objective: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been applied to virtually all solid neoplasms since our original description of LM/SL for melanoma. Our objectives were to determine the diagnostic and therapeutic utility of LM/SL, investigate carbon dye for mapping the microanatomy of lymphatic flow within the sentinel node (SN), and determine the prognostic accuracy of molecular assessment of the SN. Methods: Since 1985, 1599 patients with AJCC Stage I/II melanoma have been treated by LM/SL at our institution and 4590 have been treated by wide excision (WE) without nodal staging. We examined the incidence of clinical nodal recurrence after WE alone, the incidence of subclinical nodal metastases found by LM/SL, and the incidence of nodal recurrence in basins with histopathology-negative SNs. Results: In 1514 LM/SL patients with a primary of known Breslow thickness, the incidence of metastasis in nodes claimed to be sentinel was 7.3%, 19.7%, 33.2%, and 39.7% for primary lesions ≤1.0, 1.01-2.0, 2.01-4.0, and >4.0 mm, respectively. In 3652 WE-only patients, the corresponding rates of nodal recurrence were 12.0%, 32.0%, 34.4%, and 30.1%. Thus, LM/SL detected only 60% of expected nodal metastases from primary melanomas

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