Ganglio centinela positivo en melanoma: factores predictivos y resultados del vaciamiento ganglionar / Positive sentinel lymph node in melanoma: predictive factors and results of completion lymph node dissection

RESUMEN Antecedentes: la biopsia del ganglio centinela (GC) es la técnica aceptada para determinar el pronóstico en estadios iniciales de melanoma cutáneo. La ventaja del vaciamiento ganglionar (VG) cuando el GC resulta positivo ha sido recientemente cuestionada. Objetivo: describir los porcentajes y factores asociados a metástasis en el GC, y en los ganglios no centinela (GnC) en los VG de pacientes con GC positivo. Material y métodos: se llevó a cabo un estudio retrospectivo de los registros clínicos y patológicos de 139 pacientes operados por melanoma cutáneo entre enero de 2012 y diciembre de 2019. Resultados: a 96 (69%) pacientes se les realizó biopsia de GC. El promedio de edad fue 61,7 años ± 17,5 (19-93); 53 (55,2%) fueron hombres. La lesión primaria estuvo ubicada en: extremidades 47 (49%), tronco 39 (40,6%), cabeza y cuello 10 (10,4%). El promedio de espesor de Breslow fue 5,01 mm (1,05- 50 mm) y se encontró ulceración en 35 casos (36,4%). El GC fue identificado en todas las oportunidades y en 39 (40,6%) fue positivo. Hubo asociación con el espesor ≥ 3 mm (p = 0,000017) y con la ulceración (p = 0,0011). A los pacientes con GC positivo se les efectuó el VG del territorio afectado: 23 axilar, 10 inguinal y 6 cervical. Veintitrés (59%) presentaron metástasis en GnC. Se asoció con el espesor (p = 0,022) y la ulceración (p = 0,019). Conclusión: existió un alto porcentaje de GnC positivos en la población estudiada, vinculado al espesor y la ulceración. Estas características, así como la dificultad de un estricto seguimiento, inducen a no abandonar el VG en pacientes con GC positivo.

ABSTRACT Background: Sentinel lymph node (SLN) biopsy is the technique accepted to determine the prognosis of early cutaneous melanomas. The advantage of lymph node dissection (LND) when SLN biopsy is positive has recently been questioned. Objective: The aim of this study is to describe the percentages and factors associated with SLN and non-sentinel node (NSN) metastases in LNDs of SLN-positive patients. Material and methods: The clinical records and pathology reports of 139 patients undergoing surgery for cutaneous melanoma between January 2012 and December 2019 were retrospectively reviewed. Results: Ninety-six (69%) patients underwent SLN biopsy. Mean age was 61.7 ± 17.5 years (19-93) and 53 (55.2%) were men. The primary lesion was located in the extremities in 47 (49%) cases, in the trunk in 39 (40.6%), and in the head and neck in 10 (10.4%). Mean Breslow thickness was 5.01 mm (1.05-50 mm) and ulceration was found in 35 cases (36.4%). The SLN was identified in all the cases and was positive in 39 (40.6%). There was an association with thickness ≥ 3 mm (p = 0.000017) and ulceration (p = 0.0011). Those patients with positive SLN biopsy underwent LND of the territory involved: axillary in 23, inguinal in 10 and cervical in 6. Twenty-three (59%) presented NSLN metastases and were associated with thickness (p = 0.022) and ulceration (p = 0.019). Conclusion: There was a high percentage of positive NSLN in the population studied which was associated with thickness and ulceration. These characteristics and the difficulty to achieve strict follow-up are the reasons for completion LND in SLN-positive patients.

Aetiology of peripheral lymphadenopathy in adults: analysis of 1724 cases seen at a tertiary care teaching hospital in southern India.

BACKGROUND: In patients presenting with peripheral lymphadenopathy, excision biopsy of the most accessible lymph node provides material to establish an early diagnosis, and is important in the management of these patients. METHODS: A retrospective study was done of 1724 lymph node biopsy specimens obtained from adult patients and submitted for histopathological examination over a 12-year period. RESULTS: About one-third (n = 614; 35.6%) of these patients had non-specific lymphadenitis. This included a heterogeneous group of disorders comprising benign follicular hyperplasia, reactive hyperplasia, marked follicular hyperplasia and reactive sinus histiocytosis. Tuberculosis lymphadenitis (n = 540; 31.3%) and malignancy (n = 447; 25.9%) were the other common causes. Of the 540 patients with tuberculosis lymphadenitis, the human immunodeficiency virus (HIV) status was tested in 424 (78.5%) patients; of these, 34 patients (8%) were HIV-seropositive. Epithelioid granulomas with caseation necrosis were more frequently seen in HIV-seronegative patients compared with HIV-seropositive ones (chi2 = 54.66; p < 0.001 ). In HIV-seropositive patients, multiple sites of lymph node involvement (chi2 = 40.597; p < 0.001), suppurative type with adjacent necrosis and panniculitis (chi2 = 68.128; p < 0.001), and non-reactive histological types (chi2 = 109.234; p < 0.001) were more commonly seen compared with HIV-seronegative patients. Kikuchi-Fujimoto disease (n = 36), Kimura disease (n = 7), Rosai-Dorfman disease (n = 6), were rare aetiological causes that have been infrequently reported from India. CONCLUSION: Awareness of the characteristic histopathological findings and uncommon aetiological causes of peripheral lymphadenopathy may spare patients from unnecessary evaluation and treatment. In HIV-positive patients, lymph node tuberculosis may be histopathologically unusual and may be suppurative or non-reactive in nearly one-third of patients.

Sentinel node localization in breast cancer using intradermal dye injection: results, influencing factors and learning curve.

To evaluate the identification rate, false negative rate, concordance, negative predictive value of sentinel node localization in breast cancer using intradermal isosulfan blue injection whether this is accurate enough for surgical approach in breast cancer surgery and whether there is a significant learning curve for this technique. Factors affecting the outcomes of the procedure are also determined. From August 2002 to September 2003, 66 cases of stage 0-IIIB operable breast cancer patients underwent sentinel lymph node biopsy before standard breast cancer operation. Overall, identification rate was 80.3%, false negative rate was 10.6%, concordance was 86.8%, negative predictive value was 83.3%, sentinel node was the only node that was positive in 45.5%, and mean operative time was 55.1 minutes. Factors found to lower sentinel node identification rate are neoadjuvant chemotherapy and large tumor (T3-4) while previous excision was not found to affect the identification rate. There is significant learning curve in this technique and this should be performed at least 40-45 cases in the learning phase to accomplish a high identification rate and lower false negative rate before implicating into clinical practice.