La técnica del ganglio centinela en pacientes con melanoma / Sentinel Lymph Node Biopsy in Patients With Melanoma

RESUMEN

Material y métodos: Se realizó biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow ≥1mm o con Breslow <1mm y ulceración, nivel de Clark IV–V o regresión. Aquellos con biopsia positiva fueron sometidos a linfadenectomía.Material y métodos: Además, se recogieron las siguientes variables sexo, edad, fototipo, localización y tipo de melanoma, niveles Breslow y Clark, ulceración, regresión, estadio inicial, TNM, cambio de estadio y fallecimiento por melanoma. Resultados: El 19,44% de los pacientes presentó ganglios positivos. Esta positividad se presentó asociada con el melanoma nodular (odds ratio cruda [ORc] 3,44; intervalo de confianza al 95% [IC 95%] 1,33–8,90) con respecto al melanoma de extensión superficial Breslow superior a 2,0 (nivel 2,1–4,0 ORc 21,14; IC 95% 2,60–172,03, nivel >4,0 ORc 23,25; IC 95% 2,44–221,73), nivel Clark IV (ORc 8,73; IC 95% 1,03–74,12), ulceración (ORc 4,86; IC 95% 1,58–14,90), estadios T3 y T4 (T3 ORc 4,20; IC 95% 1,52–11,63; T4 ORc 4,67; IC 95% 1,27–17,15), cambio de estadio (ORc 7,20; IC 95% 2,25–22,99) y fallecimiento por melanoma (ORc 8,67; IC 95% 3,62–96,15). Conclusiones: Estos resultados confirman la importancia pronóstica de la biopsia del ganglio centinela, que permite identificar a los pacientes con mayor tendencia a la progresión de la enfermedad y fallecimiento por melanoma (AU)

ABSTRACT

Introduction and objectives: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. Material and methods: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics Breslow thickness ≥1mm, Breslow thickness <1mm with ulceration, Clark level IV–V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. Results: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33–8.90); Breslow thickness >2.0, for a thickness of 2.1–4.0 (ORc, 21.12; 95% CI, 2.60–172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44–221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03–74.12); ulceration (ORc, 4.86; 95% CI, 1.58–14.90); T3 (ORc, 4.20; 95% CI, 1.52–11.63) and T4 (ORc, 4.67; 95% CI, 1.27–17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25–22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62–96.15). Conclusions: These results confirm the prognostic importance of sentinel lymph node biopsy (AU)