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Sentinel Lymph Node Biopsy. Is it useful?

01 Mar

Hi everybody,

Well I did say that my next blog post would be in a weeks time but I have recently read an article that caught my eye and somewhat relates to skin pathology.

The article was entitled  ‘Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis’ and was in the February 9th, 2011 issue of the Journal of the American Medical Association. Although this relates to patients with breast cancer I wonder if there will be any overflow of this argument into the ongoing debate over the use of sentinel lymph node biopsy (SLNB) with regards to patients with melanoma.

The results of the aforementioned study showed “among patients with limited sentinel lymph node (SLN) metastatic breast cancer treated with breast conservation and systemic therapy, the use of SLND (sentinel lymph node dissection) alone compared with ALND (axillary lymph node dissection) did not result in inferior survival.” This result has also been mirrored in multiple melanoma SLNB studies. Many people have and still continue to argue over the pros (eg. without a SLNB it is not possible to accurately stage melanoma according to international guidelines) and cons (eg. the impact of complete lymph node dissection (CLND) on a patient’s immune capability).

I wonder if in the future SLNB will remain standard practice or if it was a good idea at the time.

Many thanks for reading and hopefully this post will get some interesting comments and I am sure it will.

Also don’t forget to follow me on twitter (@skinpathology)

Paul Drury

http://www.skinpathonline.com (will be up in the near future)

PS. This is the link for the JAMA article (http://jama.ama-assn.org/content/305/6/569.abstract)

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5 Comments

Posted by on March 1, 2011 in Uncategorized

 

Tags: , , , , , , , , , ,

5 responses to “Sentinel Lymph Node Biopsy. Is it useful?

  1. M.Barigou

    March 1, 2011 at 9:17 pm

    Hello,
    i just wanted to point out that the real value of SLNB in MM is when this test reveals malignancy, though it could never eliminate metastases.
    In about 15%¨of negative SLNB, metastases has been present in other sites

     
    • skinpathonline

      March 2, 2011 at 6:00 am

      Hi,
      Thanks for the comment. I thought this subject would get some comments. Even if when a SLN shows the presence of tumour is it for definite that this will result in systemic metastases? I say this because would you not expect melanoma cells to be present in a lymph node in a normal immune response from a patient with melanoma? Another point is that there is no effective treatment for systemic metastases of melanoma therefore if you see tumour in the SLN does the patient benefit from the resulting treatment, and would the treatment (lymph node dissection) not compromise the patient’s local immune response which is necessary for the patient to survive?

      PS – I am on the side line of this argument and am just an avid follower of the topic.

       
  2. M.Barigou

    March 3, 2011 at 10:11 am

    Hi,
    You’ll find all the answers you need here:

    “Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes”
    http://www.eblue.org/article/S0190-9622%2810%2900317-8/abstract
    take a look at the full text, on the discussion paragraph.

    “Interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) in clinical stage I melanoma”:
    http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=34&abstractID=31917

    “SURGICAL MANAGEMENT OF MELANOMA”
    http://www.cancerforum.org.au/File/2006/May/CF06May_103-107.pdf

     
  3. molehunter

    March 10, 2011 at 8:20 pm

    Hi. This subject was discussed at the January 2011 meeting of the UK Melanoma Study Group which I attended. There remains much uncertainty. There is no evidence that SLNB prolongs survival, it is essentially a staging measure. Up until now, it has been a valid comment that since there are no effective systemic melanoma treatments, why use an invasive procedure just for staging? However, with Ipilimumab, PLX4032 and other very promising new compounds perhaps only months from the market, staging may become much more important.

     

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