Open AccessEffect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma
Author(s) -
Moncrieff M. D.,
O'Leary F. M.,
Beadsmoore C. J.,
Pawaroo D.,
Heaton M. J.,
Isaksson K.,
Olofsson Bagge R.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11460
Subject(s) - medicine , sentinel lymph node , melanoma , biopsy , hazard ratio , sentinel node , proportional hazards model , surgery , survival analysis , lymph node , radiology , confidence interval , cancer , breast cancer , cancer research
Background Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival. Methods Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan–Meier survival analysis was used to assess overall (OS), disease‐specific (DSS) and progression‐free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis. Results A total of 2270 patients were identified. Median follow‐up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits ( P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS ( P = 0·017) and DSS ( P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008). Conclusion Delaying SLNB beyond 12 h after lymphoscintigraphy with 99 Tc‐labelled nanocolloid has a significant negative survival impact in patients with melanoma.