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J Clin Oncol. 2011 Apr 10;29(11):1479-87. doi: 10.1200/JCO.2010.33.1884. Epub 2011 Mar 7.

Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis.

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  • 1Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

PURPOSE:

To perform a meta-analysis of all published studies of sentinel lymph node (SLN) biopsy for staging patients with melanoma.

METHODS:

Published literature in all languages between 1990 and 2009 was critically appraised. Primary outcomes evaluated included the proportion successfully mapped (PSM) and test performance including false-negative rate (FNR), post-test probability negative (PTPN), and positive predictive value in the same nodal basin recurrence.

RESULTS:

A total of 71 studies including 25,240 patients met full eligibility criteria. The average PSM was 98.1% (95% CI, 97.3% to 98.6%) and increased with the year of publication, female sex, ulceration, age, and the quality score of the studies. The FNR ranged from 0.0% to 34.0%, averaging 12.5% overall (95% CI, 11% to 14.2%). FNR increased with the length of follow-up (P = .002) but decreased with greater PSM (P = .001). PTPN averaged 3.4% (95% CI, 3.0% to 3.8%), which also increased in studies with longer follow-up, younger age, female sex, deeper Breslow thickness, and with tumor ulceration while decreasing with greater PSM (P < .001). Approximately 20% of the patients with a positive SLN had additional lymph nodes in the complete lymph node dissection and 7.5% of the patients with positive SLN developed recurrence in the same nodal basin which was greater in studies that also reported higher FNR (P = .01).

CONCLUSION:

The estimated risk of nodal recurrence after a negative SLN biopsy was ≤ 5% supporting the use of this technology for staging patients with melanoma.

PMID:
21383281
[PubMed - indexed for MEDLINE]
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