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Complications Associated With Sentinel Lymph Node Biopsy for Melanoma

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Sentinel lymph node (SLN) biopsy has become widely accepted as ... cutaneous melanomas =1.0 mm Breslow thickness and. clinically negative regional lymph nodes ... – PowerPoint PPT presentation

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Title: Complications Associated With Sentinel Lymph Node Biopsy for Melanoma


1
Complications Associated With Sentinel Lymph Node
Biopsy for Melanoma
  • Journal Club Presentation
  • Tushar Halder
  • 1/09/03

2
Overview
  • Sentinel lymph node (SLN) biopsy has become
    widely accepted as a method of staging the
    regional lymph nodes for patients with melanoma.
  • SLN biopsy is a minimally invasive procedure
    associated with few complications
  • Little evidence is available in the literature to
    support this claim

3
Background
  • Purpose
  • to determine the morbidity associated with SLN
    biopsy
  • To compare the morbidity of SLN biopsy with that
    of completion lymph node dissection (CLND)
  • Hypothesis- complications associated with SLN
    biopsy are less than those associated with CLND
    or elective lymph node dissection (ELND)

4
Methods
  • A randomised prospective trial involving 70
    institutions across the United States, between
    June 1997 and June 2001
  • Complications associated with SLN biopsy alone
    were compared with those associated with SLN
    biopsy plus CLND.
  • Inclusion criteria-
  • Patients 18 to 70 years old with
  • cutaneous melanomas gt1.0 mm Breslow thickness
    and
  • clinically negative regional lymph nodes

5
Methods
  • Both radioactive colloid and isosulfan blue dye
    injection used to identify SLN
  • Histological analysis was done with hematoxylin
    and eosin staining at multiple levels, followed
    by immunohistochemical staining for S-100 protein
  • Frozen-section analysis of SLNs was not performed

6
Result
  • A total of 2120 patients were evaluated, with
  • A median follow-up of 16 months
  • 96 (4.6) of 2120 patients developed major or
    minor complications associated with SLN biopsy
  • 103 (23.2) of 444 patients experienced
    complications associated with SLN biopsy plus
    CLND
  • There were no deaths associated with either
    procedure

7
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8
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9

10
Conclusion
  • SLN biopsy alone is associated with significantly
    less morbidity compared with SLN biopsy plus CLND
  • Most complications of SLN biopsy were minor and
    easily managed.
  • Lymphedema can result from SLN biopsy alone in
    rare cases

11
Strengths of Study
  • A randomised prospective multi-institutional
    study
  • Sample size was adequate
  • A total of 2120 patients were enrolled in the
    study
  • 1676 patients underwent SLN biopsy alone, and
  • 444 underwent SLN biopsy followed by CLND
  • The frequency of complications was also evaluated
    by nodal basin distribution

12
Weakness of the Study
  • The comparison in this study was not between SLN
    biopsy and ELND
  • Lymphedema was not evaluated in this study by
    prospective evaluation of limb volume or
    circumference, but was defined as clinically
    apparent swelling of the extremity
  • The median follow-up for the study was 16 months

13
Applicability to Clinical Practice
  • This study provided evidence to support the SLN
    biopsy as a less invasive procedure associated
    with minimum complications
  • It presented ideas for future research between
    SLN biopsy and ELND
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