Skip to main content
SpringerLink
Log in

Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Some melanoma patients who undergo sentinel lymph node (SLN) biopsy will have false-negative (FN) results. We sought to determine the factors and outcomes associated with FN SLN biopsy.

Methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma of thickness > 1.0 mm who underwent SLN biopsy. FN results were defined as the proportion of node-positive patients who had a tumor-negative sentinel node biopsy. Kaplan–Meier survival analysis and univariate and multivariate analyses were performed.

Results

This analysis included 2,451 patients with median follow-up of 61 months. FN, true-positive (TP), and true-negative (TN) SLN results were found in 59 (10.8%), 486 (19.8%), and 1,906 (77.8%) patients, respectively. On univariate analysis comparing the FN with TP groups, respectively, the following factors were significantly different: age (52.6 vs. 47.6 years, p = 0.004), thickness (mean 2.1 vs. 3.1 mm, p = 0.003), lymphovascular invasion (LVI; 3.7 vs. 13.7%, p = 0.037), and local/in-transit recurrence (LITR; 32.2 vs. 12.4%, p < 0.0001); these factors remained significant on multivariate analysis. Overall 5-year survival was greater in the TN group (86.7%) compared with the TP (62.3%) and FN (51.3%) groups (p < 0.0001); however, there was no significant difference in overall survival comparing the TP and FN groups (p = 0.32).

Conclusions

This is the largest study to evaluate FN SLN results in melanoma, with a FN rate of 10.8%. FN results are associated with greater patient age, lower mean thickness, less frequent LVI, and greater risk of LITR. However, survival of patients with FN SLN is not statistically worse than that of patients with TP SLN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts and Figures, 2007. 2007.

  2. Chao C, Wong SL, Edwards MJ, et al. Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol. 2003;10:21–6.

    Article  PubMed  Google Scholar 

  3. Chao C, Martin RC, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11:259–264.

    Article  PubMed  Google Scholar 

  4. McMasters KM. Multiple nodal basin drainage in truncal melanomas. Ann Surg Oncol. 2000;7:249–250.

    Article  CAS  PubMed  Google Scholar 

  5. McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol. 2004;86:212–23.

    Article  PubMed  Google Scholar 

  6. Scoggins CR, Ross MI, Reintgen DS, et al. Gender-related differences in outcome for melanoma patients. Ann Surg. 2006;243:693–698.

    Article  PubMed  Google Scholar 

  7. Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–3634.

    CAS  PubMed  Google Scholar 

  8. Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. 1992;8:400–14.

    Article  CAS  PubMed  Google Scholar 

  9. Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.

    CAS  PubMed  Google Scholar 

  10. Thomas JM, Patocskai EJ. The argument against sentinel node biopsy for malignant melanoma. BMJ. 2000;321:3–4.

    Article  CAS  PubMed  Google Scholar 

  11. Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23.

    Article  PubMed  Google Scholar 

  12. Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242:302–11.

    PubMed  Google Scholar 

  13. Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol. 1998;16:2253–60.

    CAS  PubMed  Google Scholar 

  14. Leong SP, Kashani-Sabet M, Desmond RA, et al. Clinical significance of occult metastatic melanoma in sentinel lymph nodes and other high-risk factors based on long-term follow-up. World J Surg. 2005;29:683–691.

    Article  PubMed  Google Scholar 

  15. Cochran AJ, Morton DL. Detection of clinically relevant melanoma metastases requires focused, not exhaustive, evaluation of sentinel lymph nodes. Am J Surg Pathol. 2006;30:419–20.

    PubMed  Google Scholar 

  16. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–7.

    Article  CAS  PubMed  Google Scholar 

  17. McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer–not yet the standard of care. N Engl J Med. 1998;339:990–5.

    Article  CAS  PubMed  Google Scholar 

  18. Jansen L, Nieweg OE, Peterse JL, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg. 2000;87:484–489.

    Article  CAS  PubMed  Google Scholar 

  19. Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71.

    Article  PubMed  Google Scholar 

  20. Carlson GW, Page AJ, Cohen C, et al. Regional recurrence after negative sentinel lymph node biopsy for melanoma. Ann Surg. 2008;248:378–386.

    PubMed  Google Scholar 

  21. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.

    Article  CAS  PubMed  Google Scholar 

  22. Clary BM, Brady MS, Lewis JJ, et al. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg. 2001;233:250–8.

    Article  CAS  PubMed  Google Scholar 

  23. Yee VS, Thompson JF, McKinnon JG, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol. 2005;12:429–39.

    Article  PubMed  Google Scholar 

  24. Statius Muller MG, van Leeuwen PA, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with stage I or II cutaneous melanoma. Cancer. 2001;91:2401–8.

    Article  CAS  PubMed  Google Scholar 

  25. Conway WC, Faries MB, Nicholl MB, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16:1548–52.

    Article  PubMed  Google Scholar 

  26. Karim RZ, Scolyer RA, Li W, et al. False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology. Ann Surg. 2008;247:1003–10.

    Article  PubMed  Google Scholar 

  27. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.

    CAS  PubMed  Google Scholar 

  28. Riber-Hansen R, Sjoegren P, Hamilton-Dutoit SJ, et al. Extensive pathological analysis of selected melanoma sentinel lymph nodes: high metastasis detection rates at reduced workload. Ann Surg Oncol. 2008;15:1492–501.

    Article  PubMed  Google Scholar 

  29. Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4.

    Article  PubMed  Google Scholar 

  30. Kretschmer L, Beckmann I, Thoms KM, et al. Factors predicting the risk of in-transit recurrence after sentinel lymphonodectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol. 2006;13:1105–12.

    Article  PubMed  Google Scholar 

  31. Kang JC, Wanek LA, Essner R, et al. Sentinel lymphadenectomy does not increase the incidence of in-transit metastases in primary melanoma. J Clin Oncol. 2005;23:4764–70.

    Article  PubMed  Google Scholar 

  32. Kretschmer L, Beckmann I, Thoms KM, et al. Sentinel lymphonodectomy does not increase the risk of loco-regional cutaneous metastases of malignant melanomas. Eur J Cancer. 2005;41:531–8.

    Article  CAS  PubMed  Google Scholar 

  33. Nowecki ZI, Rutkowski P, Nasierowska-Guttmejer A, et al. Survival analysis and clinicopathological factors associated with false-negative sentinel lymph node biopsy findings in patients with cutaneous melanoma. Ann Surg Oncol. 2006;13:1655–63.

    Article  PubMed  Google Scholar 

  34. Caraco C, Marone U, Celentano E, et al. Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14:2662–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to sincerely thank Deborah Hulsewede, Sherri Matthews, Wanda Greenwell, Pam Harlan, Alex Scoggins, and Ivan Deyahs for their dedication and hard work in managing the Sunbelt Melanoma Trial. We also express gratitude to Advertek, Inc., for the expert data management. Finally, we thank all of the centers and investigators who participated in the trial.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA

    Charles R. Scoggins MD, MBA, Robert C. G. Martin MD, PhD & Kelly M. McMasters MD, PhD

  2. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Merrick I. Ross MD & Jeffrey E. Gershenwald MD

  3. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Michael J. Edwards MD & Jeffrey J. Sussman MD

  4. Lakeland Regional Cancer Center, Lakeland, FL, USA

    Douglas S. Reintgen MD

  5. Department of Surgery, University of Alabama, Birmingham, AL, USA

    Marshall M. Urist MD

  6. LDS Hospital, Salt Lake City, UT, USA

    R. Dirk Noyes MD

  7. Cancer Institute of New Jersey, New Brunswick, NJ, USA

    James S. Goydos MD

  8. Dallas Surgical Group, Dallas, TX, USA

    Peter D. Beitsch MD

  9. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Stephan Ariyan MD

  10. Department of Statistics, University of Kentucky, Lexington, KY, USA

    Arnold J. Stromberg PhD

  11. Advertek, Inc., Louisville, KY, USA

    Lee J. Hagendoorn MBA

Authors
  1. Charles R. Scoggins MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. G. Martin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Merrick I. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael J. Edwards MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas S. Reintgen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marshall M. Urist MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeffrey E. Gershenwald MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeffrey J. Sussman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Dirk Noyes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. James S. Goydos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Peter D. Beitsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stephan Ariyan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Arnold J. Stromberg PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Lee J. Hagendoorn MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kelly M. McMasters MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles R. Scoggins MD, MBA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scoggins, C.R., Martin, R.C.G., Ross, M.I. et al. Factors Associated with False-Negative Sentinel Lymph Node Biopsy in Melanoma Patients. Ann Surg Oncol 17, 709–717 (2010). https://doi.org/10.1245/s10434-009-0858-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0858-x

Keywords

Search

Navigation