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Pelvic lymph node status prediction in melanoma patients with inguinal lymph node metastasis

Pasquali, Sandroa; Mocellin, Simonea; Bigolin, Francescoa; Vecchiato, Antonellab; Montesco, Maria C.c; Di Maggio, Antoniod; Rossi, Carlo R.a,b

Melanoma Research:
doi: 10.1097/CMR.0000000000000109
ORIGINAL ARTICLES: Clinical research
Abstract

The extent of the groin lymph node (LN) dissection for melanoma is still being debated, particularly in the case of micrometastasis (sentinel lymph node positive). We tested the predictive values of the criteria for pelvic dissection currently suggested by national guidelines (number of positive inguinal LN, Cloquet’s LN status, and preoperative computed tomographic scan) and the inguinal lymph node ratio (LNR, the ratio between metastatic and excised LNs) to identify patients with pelvic metastasis. We analyzed the predictive values of the above-mentioned criteria in 157 patients who underwent an ilioinguinal dissection, with a focus on their negative predictive values (NPV), which might help identify low-risk patients who might safely avoid pelvic dissection, pelvic dissection reduction, and error rate. Forty-four (26.7%) patients had pelvic LN metastasis. In patients with micrometastasis (17.3% had pelvic LN metastasis), LNR less than 0.1 and Cloquet’s LN status achieved clinically relevant NPV (95.7 and 95.5%, respectively) and pelvic dissection reduction (38.4 and 84.6%, respectively), whereas the error rate was 1.7 and 3.0%, respectively. Lower NPVs were observed for number of positive inguinal LNs (88.6%) and computed tomographic scan (78.4%). Accuracy was enhanced when these criteria were considered in multivariable models. In patients with macrometastasis (36.8% had pelvic LN metastasis), LNR and current selection criteria achieved low NPVs and a high error rate. Avoiding pelvic dissection may be safe in sentinel lymph node-positive patients with LNR less than 0.1. The prediction of pelvic metastasis seems to be less accurate for patients with clinically positive LNs.

Author Information

aSurgery Branch, Department of Surgery, Oncology and Gastroenterology, University of Padova

bMelanoma and Sarcomas Unit

cPathology Unit

dRadiology Unit, Veneto Institute of Oncology, IRCCS, Padova, Italy

Correspondence to Sandro Pasquali, MD, Surgery Branch, Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128 Padova, Italy Tel: +39 049 821 1851; fax: +39 049 651891; e-mail: pasqualisandro@hotmail.com

Received February 10, 2014

Accepted June 6, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins