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Prognostic false-positivity of the sentinel node in melanoma

Nature Clinical Practice Oncology volume 5, pages 18–23 (2008)Cite this article

Abstract

It is a basic tenet of the sentinel lymph-node biopsy procedure that all positive sentinel lymph nodes will inevitably progress to palpable nodal recurrence if not removed. Comparison of survival is, therefore, considered permissible among patients with positive sentinel lymph nodes who undergo early lymphadenectomy with that among patients who have delayed lymphadenectomy for palpable regional node metastasis, providing that survival is calculated from the date of wide local excision of the primary tumor. Here, that fundamental assumption is contested and evidence is presented to show that a positive sentinel lymph node might have no adverse prognostic relevance in up to one-third of patients. Furthermore, in the same patients, progression to palpable nodal disease might not have occurred even if the positive sentinel node had not been removed. The term prognostic false-positivity is used to describe this phenomenon. Such patients are incorrectly up-staged, are given inaccurate prognostic information and can undergo unnecessary completion lymphadenectomy and unnecessary adjuvant therapy.

Key Points

  • Prognostic false-positivity in the sentinel nodes of patients with melanoma is a reality

  • Such patients can be wrongly up-staged, might be given inaccurate prognostic information, and might undergo unnecessary lymphadenectomy and possibly unnecessary adjuvant therapy

  • A mathematical model suggests that the incidence of prognostic false-positivity in MSLT-1 is 24% for intermediate thickness tumors and 34% for all strata at the third interim analysis

  • Prognostic false-positivity has important implications for the management of patients with primary melanoma

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Figure 1: A flow diagram of patients with intermediate thickness melanoma entered and randomized to MSLT-1 with a mathematical explanation of how prognostic false-positivity was calculated.
Figure 2: A flow diagram of all patients entered and randomized into MSLT-1 with a mathematical explanation of how prognostic false-positivity was calculated.

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Author notes

  1. The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK meirion@roseway.demon.co.uk

Authors and Affiliations

  1. JM Thomas is Professor of Surgical Oncology at the Royal Marsden Hospital and Imperial College, London, UK.,

    J Meirion Thomas

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  1. J Meirion Thomas
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Thomas, J. Prognostic false-positivity of the sentinel node in melanoma. Nat Rev Clin Oncol 5, 18–23 (2008). https://doi.org/10.1038/ncponc1014

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