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Routine retrieval of pelvic sentinel lymph nodes for melanoma rarely adds prognostic information or alters management

Swords, Douglas S.a,b; Andtbacka, Robert H.I.a; Bowles, Tawnya L.a,b; Hyngstrom, John R.a,b

doi: 10.1097/CMR.0000000000000498
ORIGINAL ARTICLES: Clinical research
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Pelvic sentinel lymph nodes (SLNs) are commonly identified during inguinal SLN biopsy for melanoma, but retrieval is not uniform among surgeons/centers. Few studies have assessed rates of micrometastases in pelvic versus superficial inguinal SLNs. Previous studies suggested that presence of pelvic SLNs was predicted by aggressive pathologic features and that their presence portended a worse prognosis. The objectives of this study were to examine presurgical predictors of pelvic SLNs among patients undergoing inguinal SLN biopsy, assess rates of micrometastases in superficial inguinal versus pelvic SLNs, and determine whether presence of pelvic SLNs was associated with long-term outcomes. Multivariable regression was used to assess presurgical factors associated with presence of pelvic SLNs. Rates of micrometastases in superficial inguinal versus pelvic SLNs in patients who had a pelvic SLN were compared with McNemar’s test. Groin recurrence, disease-free survival (DFS), and disease-specific survival were analyzed by Kaplan–Meier method. A multivariable Cox model for DFS was performed. Pelvic SLNs were retrieved in 100/537 (18.6%) superficial inguinal SLN biopsies and no preoperative factors predicted their presence. In patients with a pelvic SLN, micrometastases were present in 3.0% of pelvic versus 34.0% of superficial inguinal SLN biopsies (P<0.001). There were no differences in groin recurrence, DFS, and disease-specific survival for patients with/without pelvic SLNs in univariate analyses (all P>0.2) or in the multivariable Cox model for DFS (hazard ratio: 1.1, 95% confidence interval: 0.6–2.1). In conclusion, pelvic SLNs harbor micrometastases less frequently than superficial inguinal SLNs do, suggesting that omission of pelvic SLN biopsy may be reasonable.

aDepartment of Surgery, University of Utah

bIntermountain Healthcare, Surgical Services, Intermountain Medical Center, Salt Lake City, Utah, USA

Correspondence to Douglas S. Swords, MD, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA Tel: +1 801 581 7738; fax: +1 801 585 1520; e-mail: douglas.swords@hsc.utah.edu

Received April 25, 2018

Accepted July 23, 2018

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