False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology

Karim, RZ; Scolyer, RA; Li, W; Yee, VSK; McKinnon, JG; Li, LXL; Uren, RF; Lam, S; Beavis, A; Dawson, M; Doble, P; Hoon, DSB; Thompson, JF

False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology

Karim, RZ Scolyer, RA Li, W Yee, VSK McKinnon, JG Li, LXL Uren, RF Lam, S Beavis, A

Dawson, M Doble, P

Hoon, DSB Thompson, JF

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Publication Type:: Journal Article
Citation:: Annals of Surgery, 2008, 247 (6), pp. 1003 - 1010
Issue Date:: 2008-06-01

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Field	Value	Language
dc.contributor.author	Karim, RZ	en_US
dc.contributor.author	Scolyer, RA	en_US
dc.contributor.author	Li, W	en_US
dc.contributor.author	Yee, VSK	en_US
dc.contributor.author	McKinnon, JG	en_US
dc.contributor.author	Li, LXL	en_US
dc.contributor.author	Uren, RF	en_US
dc.contributor.author	Lam, S	en_US
dc.contributor.author	Beavis, A https://orcid.org/0000-0001-6259-7699	en_US
dc.contributor.author	Dawson, M	en_US
dc.contributor.author	Doble, P https://orcid.org/0000-0002-8472-1301	en_US
dc.contributor.author	Hoon, DSB	en_US
dc.contributor.author	Thompson, JF	en_US
dc.date.issued	2008-06-01	en_US
dc.identifier.citation	Annals of Surgery, 2008, 247 (6), pp. 1003 - 1010	en_US
dc.identifier.issn	0003-4932	en_US
dc.identifier.uri	http://hdl.handle.net/10453/9605
dc.description.abstract	OBJECTIVE: To investigate a cohort of melanoma patients with false negative (FN) sentinel node (SN) biopsies (SNBs) to identify the reasons for the FN result. SUMMARY OF BACKGROUND DATA: SNB is a highly efficient staging method in melanoma patients. However, with long-term follow-up FN SNB results of up to 25% have been reported. METHODS: Seventy-four SNs from 33 patients found to have had an FN SNB were analyzed by reviewing the lymphoscintigraphy, surgical data, and histopathology, and by assessing nodal tissue using multimarker real-time quantitative reverse transcription (qRT) polymerase chain reaction, and antimony concentration measurements (as a marker of "true" SN status) using inductively coupled plasma mass spectroscopy. RESULTS: Nine SNs (12%) from 9 patients (27%) had evidence of melanoma on histopathologic review. Twelve SNs (16%) from 10 patients (30%) were qRT(+). Four of these 12 SNs were positive on histopathology review and 8 were negative. Four patients (12%) were upstaged by qRT. Sixteen patients had their SNB histology, lymphoscintigraphy, and surgical data reviewed. Identifiable causes of the FN SNBs were not found after review of all modalities in 4 patients. SNs from all 4 patients had antimony levels indicative of an SN. Of the SNs evaluable by qRT, 1 was qRT(+) and 7 SNs from 2 patients were qRT(-). CONCLUSIONS: An FN SN can occur because of deficiencies in nuclear medicine, surgery, or pathology. qRT can detect "occult" metastatic melanoma in SNs that have been identified as negative by histopathology. © 2008 Lippincott Williams & Wilkins, Inc.	en_US
dc.relation.ispartof	Annals of Surgery	en_US
dc.relation.isbasedon	10.1097/SLA.0b013e3181724f5e	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Melanoma	en_US
dc.subject.mesh	Skin Neoplasms	en_US
dc.subject.mesh	Lymphatic Metastasis	en_US
dc.subject.mesh	Neoplasm Recurrence, Local	en_US
dc.subject.mesh	Antimony	en_US
dc.subject.mesh	Technetium Compounds	en_US
dc.subject.mesh	Tumor Markers, Biological	en_US
dc.subject.mesh	Radiopharmaceuticals	en_US
dc.subject.mesh	Diagnostic Errors	en_US
dc.subject.mesh	False Negative Reactions	en_US
dc.subject.mesh	Sentinel Lymph Node Biopsy	en_US
dc.subject.mesh	Neoplasm Staging	en_US
dc.subject.mesh	Immunohistochemistry	en_US
dc.subject.mesh	Reverse Transcriptase Polymerase Chain Reaction	en_US
dc.subject.mesh	Biomarkers, Tumor	en_US
dc.subject.mesh	Radionuclide Imaging	en_US
dc.title	False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology	en_US
dc.type	Journal Article
utslib.citation.volume	6	en_US
utslib.citation.volume	247	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Chemistry and Forensic Science
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Mathematical and Physical Sciences
pubs.organisational-group	/University of Technology Sydney/Strength - CFS - Centre for Forensic Science
utslib.copyright.status	closed_access
pubs.issue	6	en_US
pubs.publication-status	Published	en_US
pubs.volume	247	en_US

Abstract:

OBJECTIVE: To investigate a cohort of melanoma patients with false negative (FN) sentinel node (SN) biopsies (SNBs) to identify the reasons for the FN result. SUMMARY OF BACKGROUND DATA: SNB is a highly efficient staging method in melanoma patients. However, with long-term follow-up FN SNB results of up to 25% have been reported. METHODS: Seventy-four SNs from 33 patients found to have had an FN SNB were analyzed by reviewing the lymphoscintigraphy, surgical data, and histopathology, and by assessing nodal tissue using multimarker real-time quantitative reverse transcription (qRT) polymerase chain reaction, and antimony concentration measurements (as a marker of "true" SN status) using inductively coupled plasma mass spectroscopy. RESULTS: Nine SNs (12%) from 9 patients (27%) had evidence of melanoma on histopathologic review. Twelve SNs (16%) from 10 patients (30%) were qRT(+). Four of these 12 SNs were positive on histopathology review and 8 were negative. Four patients (12%) were upstaged by qRT. Sixteen patients had their SNB histology, lymphoscintigraphy, and surgical data reviewed. Identifiable causes of the FN SNBs were not found after review of all modalities in 4 patients. SNs from all 4 patients had antimony levels indicative of an SN. Of the SNs evaluable by qRT, 1 was qRT(+) and 7 SNs from 2 patients were qRT(-). CONCLUSIONS: An FN SN can occur because of deficiencies in nuclear medicine, surgery, or pathology. qRT can detect "occult" metastatic melanoma in SNs that have been identified as negative by histopathology. © 2008 Lippincott Williams & Wilkins, Inc.

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http://hdl.handle.net/10453/9605