Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature
OBJECTIVE To determine the diagnostic accuracy and usefulness of sentinel lymph node biopsy (SLNB) and computed tomographic scans in the initial evaluation and treatment of patients with Merkel cell carcinoma (MCC). DESIGN Single-institution case series and literature-based case-level meta-analysis....
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| Veröffentlicht in: | Archives of dermatology (1960) 2006-06, Vol.142 (6), p.685-690 |
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| creator | Gupta, Sheela G Wang, Linda C Peñas, Pablo F Gellenthin, Martina Lee, Stephanie J Nghiem, Paul |
| description | OBJECTIVE To determine the diagnostic accuracy and usefulness of sentinel lymph node biopsy (SLNB) and computed tomographic scans in the initial evaluation and treatment of patients with Merkel cell carcinoma (MCC). DESIGN Single-institution case series and literature-based case-level meta-analysis. SETTING Academic cutaneous oncology clinic. PATIENTS Sixty-one adults with biopsy-proven MCC (30 who had undergone SLNB) plus 92 cases from the literature of patients who had undergone SLNB. MAIN OUTCOME MEASURES Relapse-free survival. RESULTS In 122 patients with no nodal disease found by physical examination, SLNB findings revealed nodal involvement in 39 cases (32%). At 3 years, the recurrence rate for those with a positive SLNB was 3 times (60%) higher than for those with a negative SLNB (20%; P = .03). Patients with a positive SLNB who received adjuvant nodal therapy had a relapse-free survival rate of 51% at 3 years (n = 26) compared with 0% for patients who did not receive nodal therapy (n = 3; P |
| doi_str_mv | 10.1001/archderm.142.6.685 |
| format | Article |
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DESIGN Single-institution case series and literature-based case-level meta-analysis. SETTING Academic cutaneous oncology clinic. PATIENTS Sixty-one adults with biopsy-proven MCC (30 who had undergone SLNB) plus 92 cases from the literature of patients who had undergone SLNB. MAIN OUTCOME MEASURES Relapse-free survival. RESULTS In 122 patients with no nodal disease found by physical examination, SLNB findings revealed nodal involvement in 39 cases (32%). At 3 years, the recurrence rate for those with a positive SLNB was 3 times (60%) higher than for those with a negative SLNB (20%; P = .03). Patients with a positive SLNB who received adjuvant nodal therapy had a relapse-free survival rate of 51% at 3 years (n = 26) compared with 0% for patients who did not receive nodal therapy (n = 3; P<.01). In contrast, among patients with a negative SLNB there was no significant difference in 3-year relapse-free survival rates for those who did (90%; n = 24) or did not (70%; n = 19; P = .26) receive adjuvant nodal therapy. Using SLNB plus clinical follow-up as a gold standard, computed tomographic scans had low sensitivity (20%) for detecting MCC that had spread to the lymph node basin and low specificity for distant disease (only 4 of 21 “positive” scans were confirmed during 6 months of follow-up). CONCLUSIONS Sentinel lymph node biopsy detects MCC spread in one third of patients whose tumors would have otherwise been clinically and radiologically understaged and who may not have received treatment to the involved node bed. There was a significant benefit of adjuvant nodal therapy, but only when the SLNB was positive. Thus, SLNB is important for both prognosis and therapy and should be performed routinely for patients with MCC. In contrast, computed tomographic scans have poor sensitivity in detecting nodal disease as well as poor specificity in detecting distant disease.Arch Dermatol. 2006;142:685-690--></description><identifier>ISSN: 0003-987X</identifier><identifier>ISSN: 2168-6068</identifier><identifier>EISSN: 1538-3652</identifier><identifier>EISSN: 2168-6084</identifier><identifier>DOI: 10.1001/archderm.142.6.685</identifier><identifier>PMID: 16785370</identifier><identifier>CODEN: ARDEAC</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Age ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Biopsy ; Boston ; Cancer ; Carcinoma, Merkel Cell - diagnosis ; Carcinoma, Merkel Cell - diagnostic imaging ; Carcinoma, Merkel Cell - pathology ; Carcinoma, Merkel Cell - therapy ; Chemotherapy ; Data analysis ; Dermatology ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis - diagnosis ; Lymphatic Metastasis - diagnostic imaging ; Lymphatic Metastasis - pathology ; Lymphatic system ; Male ; Medical sciences ; Medical treatment ; Meta-analysis ; Middle Aged ; Neoplasm Recurrence, Local - diagnosis ; Neoplasm Recurrence, Local - diagnostic imaging ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - therapy ; Predictive Value of Tests ; Radiation therapy ; Sentinel Lymph Node Biopsy - standards ; Skin Neoplasms - diagnosis ; Skin Neoplasms - diagnostic imaging ; Skin Neoplasms - pathology ; Skin Neoplasms - therapy ; Survival analysis ; Tomography, X-Ray Computed - standards</subject><ispartof>Archives of dermatology (1960), 2006-06, Vol.142 (6), p.685-690</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright American Medical Association Jun 2006</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamadermatology/articlepdf/10.1001/archderm.142.6.685$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/archderm.142.6.685$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,315,781,785,3341,27925,27926,76490,76493</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17884074$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16785370$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Sheela G</creatorcontrib><creatorcontrib>Wang, Linda C</creatorcontrib><creatorcontrib>Peñas, Pablo F</creatorcontrib><creatorcontrib>Gellenthin, Martina</creatorcontrib><creatorcontrib>Lee, Stephanie J</creatorcontrib><creatorcontrib>Nghiem, Paul</creatorcontrib><title>Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature</title><title>Archives of dermatology (1960)</title><addtitle>Arch Dermatol</addtitle><description>OBJECTIVE To determine the diagnostic accuracy and usefulness of sentinel lymph node biopsy (SLNB) and computed tomographic scans in the initial evaluation and treatment of patients with Merkel cell carcinoma (MCC). DESIGN Single-institution case series and literature-based case-level meta-analysis. SETTING Academic cutaneous oncology clinic. PATIENTS Sixty-one adults with biopsy-proven MCC (30 who had undergone SLNB) plus 92 cases from the literature of patients who had undergone SLNB. MAIN OUTCOME MEASURES Relapse-free survival. RESULTS In 122 patients with no nodal disease found by physical examination, SLNB findings revealed nodal involvement in 39 cases (32%). At 3 years, the recurrence rate for those with a positive SLNB was 3 times (60%) higher than for those with a negative SLNB (20%; P = .03). Patients with a positive SLNB who received adjuvant nodal therapy had a relapse-free survival rate of 51% at 3 years (n = 26) compared with 0% for patients who did not receive nodal therapy (n = 3; P<.01). In contrast, among patients with a negative SLNB there was no significant difference in 3-year relapse-free survival rates for those who did (90%; n = 24) or did not (70%; n = 19; P = .26) receive adjuvant nodal therapy. Using SLNB plus clinical follow-up as a gold standard, computed tomographic scans had low sensitivity (20%) for detecting MCC that had spread to the lymph node basin and low specificity for distant disease (only 4 of 21 “positive” scans were confirmed during 6 months of follow-up). CONCLUSIONS Sentinel lymph node biopsy detects MCC spread in one third of patients whose tumors would have otherwise been clinically and radiologically understaged and who may not have received treatment to the involved node bed. There was a significant benefit of adjuvant nodal therapy, but only when the SLNB was positive. Thus, SLNB is important for both prognosis and therapy and should be performed routinely for patients with MCC. In contrast, computed tomographic scans have poor sensitivity in detecting nodal disease as well as poor specificity in detecting distant disease.Arch Dermatol. 2006;142:685-690--></description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Boston</subject><subject>Cancer</subject><subject>Carcinoma, Merkel Cell - diagnosis</subject><subject>Carcinoma, Merkel Cell - diagnostic imaging</subject><subject>Carcinoma, Merkel Cell - pathology</subject><subject>Carcinoma, Merkel Cell - therapy</subject><subject>Chemotherapy</subject><subject>Data analysis</subject><subject>Dermatology</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Lymphatic Metastasis - diagnosis</subject><subject>Lymphatic Metastasis - diagnostic imaging</subject><subject>Lymphatic Metastasis - pathology</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - diagnosis</subject><subject>Neoplasm Recurrence, Local - diagnostic imaging</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Predictive Value of Tests</subject><subject>Radiation therapy</subject><subject>Sentinel Lymph Node Biopsy - standards</subject><subject>Skin Neoplasms - diagnosis</subject><subject>Skin Neoplasms - diagnostic imaging</subject><subject>Skin Neoplasms - pathology</subject><subject>Skin Neoplasms - therapy</subject><subject>Survival analysis</subject><subject>Tomography, X-Ray Computed - standards</subject><issn>0003-987X</issn><issn>2168-6068</issn><issn>1538-3652</issn><issn>2168-6084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkd1u1DAQhSMEotvCA8AFspDKXZbxX-z0DpYWkLaAxCK4iybJRJuSP2wHsS_Ds-JlFypxw43HmvnO0YxOkjzmsOQA_Dm6aluT65dciWW2zKy-kyy4ljaVmRZ3kwUAyDS35stJcur9TdQIa8X95IRnxmppYJH8_EhDaAfq2HrXT1v2bqyJvWzHye9YMzp2-R27GUM7DgyHmm0cYeijhI0N-xD78evZ5zZs2TW5r9FmRV184mrtMPZ4wTZbYq9wwPQKXUnR8MdELsoq-m14TQHTOO52vvV70xD5dRvIYZgdPUjuNdh5enisZ8mnq8vN6k26fv_67erFOkWpbUgtloDcAKc6Q8OtsbwkbupaQFVWmJcUO8aQBFWL0gCoRiEHazQoq5SSZ8mzg-_kxm8z-VD0ra_iKTjQOPsis5BrLbP_gjzPc7DCRPDpP-DNOLt4qC-ElJznwkKExAGq3Oi9o6aYXNuj2xUcin3GxZ-Mi5hxkcU9dBQ9OTrPZU_1reQYagTOjwD6CrvG4VC1_pYz1iow-6MfHTjs8e9Ugc6NkL8AlWK5xA</recordid><startdate>20060601</startdate><enddate>20060601</enddate><creator>Gupta, Sheela G</creator><creator>Wang, Linda C</creator><creator>Peñas, Pablo F</creator><creator>Gellenthin, Martina</creator><creator>Lee, Stephanie J</creator><creator>Nghiem, Paul</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20060601</creationdate><title>Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature</title><author>Gupta, Sheela G ; Wang, Linda C ; Peñas, Pablo F ; Gellenthin, Martina ; Lee, Stephanie J ; Nghiem, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a358t-8ab0a1701ed6a718781be17dd20cbca9be78177e304d2b7004f4a108750484443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Boston</topic><topic>Cancer</topic><topic>Carcinoma, Merkel Cell - diagnosis</topic><topic>Carcinoma, Merkel Cell - diagnostic imaging</topic><topic>Carcinoma, Merkel Cell - pathology</topic><topic>Carcinoma, Merkel Cell - therapy</topic><topic>Chemotherapy</topic><topic>Data analysis</topic><topic>Dermatology</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Lymphatic Metastasis - diagnosis</topic><topic>Lymphatic Metastasis - diagnostic imaging</topic><topic>Lymphatic Metastasis - pathology</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - diagnosis</topic><topic>Neoplasm Recurrence, Local - diagnostic imaging</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>Predictive Value of Tests</topic><topic>Radiation therapy</topic><topic>Sentinel Lymph Node Biopsy - standards</topic><topic>Skin Neoplasms - diagnosis</topic><topic>Skin Neoplasms - diagnostic imaging</topic><topic>Skin Neoplasms - pathology</topic><topic>Skin Neoplasms - therapy</topic><topic>Survival analysis</topic><topic>Tomography, X-Ray Computed - standards</topic><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Sheela G</creatorcontrib><creatorcontrib>Wang, Linda C</creatorcontrib><creatorcontrib>Peñas, Pablo F</creatorcontrib><creatorcontrib>Gellenthin, Martina</creatorcontrib><creatorcontrib>Lee, Stephanie J</creatorcontrib><creatorcontrib>Nghiem, Paul</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of dermatology (1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Sheela G</au><au>Wang, Linda C</au><au>Peñas, Pablo F</au><au>Gellenthin, Martina</au><au>Lee, Stephanie J</au><au>Nghiem, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature</atitle><jtitle>Archives of dermatology (1960)</jtitle><addtitle>Arch Dermatol</addtitle><date>2006-06-01</date><risdate>2006</risdate><volume>142</volume><issue>6</issue><spage>685</spage><epage>690</epage><pages>685-690</pages><issn>0003-987X</issn><issn>2168-6068</issn><eissn>1538-3652</eissn><eissn>2168-6084</eissn><coden>ARDEAC</coden><abstract>OBJECTIVE To determine the diagnostic accuracy and usefulness of sentinel lymph node biopsy (SLNB) and computed tomographic scans in the initial evaluation and treatment of patients with Merkel cell carcinoma (MCC). DESIGN Single-institution case series and literature-based case-level meta-analysis. SETTING Academic cutaneous oncology clinic. PATIENTS Sixty-one adults with biopsy-proven MCC (30 who had undergone SLNB) plus 92 cases from the literature of patients who had undergone SLNB. MAIN OUTCOME MEASURES Relapse-free survival. RESULTS In 122 patients with no nodal disease found by physical examination, SLNB findings revealed nodal involvement in 39 cases (32%). At 3 years, the recurrence rate for those with a positive SLNB was 3 times (60%) higher than for those with a negative SLNB (20%; P = .03). Patients with a positive SLNB who received adjuvant nodal therapy had a relapse-free survival rate of 51% at 3 years (n = 26) compared with 0% for patients who did not receive nodal therapy (n = 3; P<.01). In contrast, among patients with a negative SLNB there was no significant difference in 3-year relapse-free survival rates for those who did (90%; n = 24) or did not (70%; n = 19; P = .26) receive adjuvant nodal therapy. Using SLNB plus clinical follow-up as a gold standard, computed tomographic scans had low sensitivity (20%) for detecting MCC that had spread to the lymph node basin and low specificity for distant disease (only 4 of 21 “positive” scans were confirmed during 6 months of follow-up). CONCLUSIONS Sentinel lymph node biopsy detects MCC spread in one third of patients whose tumors would have otherwise been clinically and radiologically understaged and who may not have received treatment to the involved node bed. There was a significant benefit of adjuvant nodal therapy, but only when the SLNB was positive. Thus, SLNB is important for both prognosis and therapy and should be performed routinely for patients with MCC. In contrast, computed tomographic scans have poor sensitivity in detecting nodal disease as well as poor specificity in detecting distant disease.Arch Dermatol. 2006;142:685-690--></abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>16785370</pmid><doi>10.1001/archderm.142.6.685</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Aged Aged, 80 and over Biological and medical sciences Biopsy Boston Cancer Carcinoma, Merkel Cell - diagnosis Carcinoma, Merkel Cell - diagnostic imaging Carcinoma, Merkel Cell - pathology Carcinoma, Merkel Cell - therapy Chemotherapy Data analysis Dermatology Disease-Free Survival Female Humans Lymphatic Metastasis - diagnosis Lymphatic Metastasis - diagnostic imaging Lymphatic Metastasis - pathology Lymphatic system Male Medical sciences Medical treatment Meta-analysis Middle Aged Neoplasm Recurrence, Local - diagnosis Neoplasm Recurrence, Local - diagnostic imaging Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - therapy Predictive Value of Tests Radiation therapy Sentinel Lymph Node Biopsy - standards Skin Neoplasms - diagnosis Skin Neoplasms - diagnostic imaging Skin Neoplasms - pathology Skin Neoplasms - therapy Survival analysis Tomography, X-Ray Computed - standards |
| title | Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature |
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