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Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma?
Author(s) -
Puza Charles J.,
Josyula Srirama,
Terando Alicia M.,
Howard John H.,
Agnese Doreen M.,
Mosca Paul J.,
Lee Walter T.,
Beasley Georgia M.
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25025
Subject(s) - medicine , sentinel lymph node , melanoma , lymph , biopsy , neck dissection , stage (stratigraphy) , head and neck , surgery , cancer , pathology , breast cancer , biology , paleontology , cancer research
Background and Objectives Head and neck (HN) cutaneous melanoma is associated with worse disease‐free survival compared to non‐HN cutaneous melanoma, possibly due to inadequate staging. We aim to determine if a higher yield of sentinel lymph nodes (SLNs) affected rates of sentinel lymph node biopsy (SLNB) positivity. Methods Two Cancer Registries were used to identify patients who underwent SLNB for HN melanoma. A false negative (FN) was defined by nodal recurrence after negative SLNB. Results Out of 333 patients who underwent SLNB, 20% ( n = 69) had a positive SLN with a FN rate of 6.3%. Those with three or more SLNs had a higher rate of SLN positivity (23.8% [17.5‐29.9% CI] vs 16.4% [10.7‐23.6% CI]), a lower FN rate (16.7% [10.2‐21.2% CI] vs 35.3% [27.1‐42.9% CI]), and higher sensitivity (83.3% [82.59‐84.09% CI] vs 65.7% [64.87‐66.53% CI]) compared to those with one or two SLNs. Of patients in Group 1 (one or two SLNs) with a positive SLN who underwent completion lymph node dissection (20/23), 47% (33‐61% CI) had one or more positive non‐sentinel nodes compared to 29% (16‐51%) of patients in Group 2 (three or more SLNs) (42/46). Conclusion In HN melanoma cases in which multiple nodes are identified, removal of all SLNs will more adequately stage patients.