Details

Autor(en) / Beteiligte

• Appleton, Sarah E
• Fadel, Zahir
• Williams, Jason S
• Bezuhly, Michael

Titel

Vertical growth phase as a prognostic factor for sentinel lymph node positivity in thin melanomas: a systematic review and meta-analysis

Ist Teil von

• Plastic and reconstructive surgery (1963), 2018-06, Vol.141 (6), p.1529-1540

Ort / Verlag

United States: American Society of Plastic Surgeons

Erscheinungsjahr

2018

Quelle

MEDLINE

Beschreibungen/Notizen

• BACKGROUND:The 2010 AJCC guidelines recommended consideration of sentinel lymph node (SLN) biopsy for thin melanoma (Breslow thickness < 1.0 mm) with aggressive pathological features such as ulceration and/or high mitotic rate. The therapeutic benefit of biopsy-based treatment remains controversial. The authors conducted a meta-analysis to estimate the risk and outcomes of SLN positivity in thin melanoma, and examined established and potential novel predictors of SLN positivity. METHODS:Three databases were searched by two independent reviewers for SLN positivity in patients with thin melanoma. Study heterogeneity, publication bias, and quality were assessed. Data collected included age, sex, Breslow thickness, mitotic rate, ulceration, regression, Clark’s level, tumour infiltrating lymphocytes (TIL), and vertical growth phase (VGP). SLN positivity was estimated using a random effects model. Association of SLN positivity and clinicopathological features was investigated using meta-regression. RESULTS:Ninety-three studies were identified representing 35,276 patients with thin melanoma who underwent SLN biopsy. Of these patients, 952 had a positive SLN biopsy for an event rate of 5.1 percent (95% CI 4.1-6.3). Significant associations were identified between SLN positivity and Breslow thickness greater than 0.75 mm but less than 1.0 mm, mitotic rate, ulceration, and Clark’s level >IV. Seven studies reported on VGP, which was strongly associated with SLN positivity (odds ratio 4.3; 95% CI, 2.5- 7.7). CONCLUSION:To date, this is the largest meta-analysis to examine predictors of SLN biopsy positivity in thin melanoma. VGP had a strong association with SLN biopsy positivity, providing support for its inclusion in standardized pathological reporting.