scholarly journals Analysis of Sentinel Node Biopsy and Clinicopathologic Features as Prognostic Factors in Patients With Atypical Melanocytic Tumors

2020 ◽  
Vol 18 (10) ◽  
pp. 1327-1336
Author(s):  
Andrea Maurichi ◽  
Rosalba Miceli ◽  
Roberto Patuzzo ◽  
Francesco Barretta ◽  
Gianfranco Gallino ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Mitotic Rate ◽  
Free Survival ◽  
Melanocytic Tumors ◽  
Node Biopsy

Background: Atypical melanocytic tumors (AMTs) include a wide spectrum of melanocytic neoplasms that represent a challenge for clinicians due to the lack of a definitive diagnosis and the related uncertainty about their management. This study analyzed clinicopathologic features and sentinel node status as potential prognostic factors in patients with AMTs. Patients and Methods: Clinicopathologic and follow-up data of 238 children, adolescents, and adults with histologically proved AMTs consecutively treated at 12 European centers from 2000 through 2010 were retrieved from prospectively maintained databases. The binary association between all investigated covariates was studied by evaluating the Spearman correlation coefficients, and the association between progression-free survival and all investigated covariates was evaluated using univariable Cox models. The overall survival and progression-free survival curves were established using the Kaplan-Meier method. Results: Median follow-up was 126 months (interquartile range, 104–157 months). All patients received an initial diagnostic biopsy followed by wide (1 cm) excision. Sentinel node biopsy was performed in 139 patients (58.4%), 37 (26.6%) of whom had sentinel node positivity. There were 4 local recurrences, 43 regional relapses, and 8 distant metastases as first events. Six patients (2.5%) died of disease progression. Five patients who were sentinel node–negative and 3 patients who were sentinel node–positive developed distant metastases. Ten-year overall and progression-free survival rates were 97% (95% CI, 94.9%–99.2%) and 82.2% (95% CI, 77.3%–87.3%), respectively. Age, mitotic rate/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss were factors affecting prognosis in the whole series and the sentinel node biopsy subgroup. Conclusions: Age >20 years, mitotic rate >4/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss proved to be worse prognostic factors in patients with ATMs. Sentinel node status was not a clear prognostic predictor.

scholarly journals Platelet-Rich Plasma (PRP) in Breast Cancer Patients: An Application Analysis of 163 Sentinel Lymph Node Biopsies

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
C. Eichler ◽  
C. Baucks ◽  
J. Üner ◽  
C. Pahmeyer ◽  
D. Ratiu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Sentinel Node Biopsy ◽  
Platelet Rich Plasma ◽  
Distant Metastases ◽  
Complication Rates ◽  
Breast Cancer Patients ◽  
Node Biopsy

Introduction. Literature shows platelet-rich plasma (PRP) to improve overall outcomes in orthopedics, dermatology, ophthalmology, gynecology, and plastic surgery. Data on oncological patients is very limited. Only one publication is available on PRP in breast cancer patients. This work evaluated PRP in sentinel node biopsy procedures for breast cancer patients in terms of complication rates and oncological short-term follow-up. Methods. The evaluated PRP was ACP®, i.e., autologous conditioned plasma by Arthrex®. Between 2015 and 2018, 163 patients were offered to receive an ACP®/PRP injection in their lymph node biopsy site. Recruitment resulted in an approximate one-to-one ratio for analysis. Endpoints were major (revision) and minor (seroma, hematoma, and infection) complications rates as well as distant metastases, local recurrence, and overall survival. Median follow-up was 30 months. Results. Complication rates and oncological follow-up showed PRP to be applicable to use in a sentinel node biopsy scenario in breast cancer patients. There were 0 revisions in the ACP®/PRP group and 1.2% revisions in the control group (not significant). Oncological follow-up showed zero (0) distant metastases and local recurrences as well as a 100% 30-month overall survival. Conclusions. This is the first analysis of ACP®/PRP used in breast cancer patients in a sentinel node biopsy setting worldwide. PRP does not seem to increase rates of local recurrence within this 30-month follow-up time frame. Also, trend towards decreasing complication rates could be shown.

Vulvar melanoma: A monocentric retrospective study on 29 cases.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19036-e19036
Author(s):  
Giulio Tosti ◽  
Edoardo Botteri ◽  
Giuseppe Spadola ◽  
Federica Baldini ◽  
Massimo Mosconi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Local Excision ◽  
Wide Local Excision ◽  
Distant Metastases ◽  
Node Biopsy ◽  
Vulvar Melanoma

e19036 Background: Vulvar melanoma (VM) represents 3-7% of melanoma in women. The 5-year survival rate ranges from 8 to 55%. Surgical excision represents the best definitive therapy but surgical radicality does not impact on recurrence or survival. Methods: Thirty women with histologically confirmed VM diagnosed between 1993 and 2009 were selected for this monocentric retrospective study. One patient with metastases at time of diagnosis was excluded from the statistical analysis. Clinical, pathological and follow-up data were collected. Cumulative incidences of events were calculated and compared across subgroups by means of the Gray test. Results: Average age at diagnosis was 62 years. Average Breslow thickness was 4.91 mm. Ulceration was present in 11 cases and was unknown in 5. One case of VM was multifocal at presentation. Eleven patients underwent a wide local excision, 11 a hemivulvectomy and 7 a radical vulvectomy Sentinel node biopsy was performed in 23 patients and at least one positive sentinel node was found in 8 cases. Eight patients received adjuvant therapy. Ten patients had a second tumor (other than melanoma); of these, a breast cancer was recorded in 5 cases. Four patients had a second primary melanoma: of the vulva (n=2), vagina (n=1), and urethra (n=1). Median follow-up among ongoing survivors was 79 months and median overall survival was 69 months. The 5-year overall survival was 55.4%. Median event free survival 34 months. Positive lymph nodal status was associated with an increased risk of loco-regional recurrences (P=0.04). Positive lymph nodal status (P=0.06), Breslow thickness > 2mm (P=0.05) and number of mitoses > 10/mm2 (P=0.04) increased the risk of distant metastases. Age, ulceration and type of surgery were not significantly associated with any type of event. Conclusions: Lymph node involvement, elevated depth of invasion and a high number of mitoses were the most important prognostic factors for locoregional recurrence and distant metastases. The same trends were observed for the overall survival, but results were not statistically significant. Conservative surgery in the form of wide local excision with adequate margins may replace vulvectomy. Sentinel node biopsy is feasible and its role in VM should be further investigated.

Routine PET and PET-CT scans in melanoma patients with positive sentinel node biopsy is of limited benefit

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8582-8582
Author(s):  
A. Constantinidou ◽  
M. Hofman ◽  
M. O'Doherty ◽  
K. Acland ◽  
C. Healy ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Pet Scan ◽  
Positive Sentinel Node ◽  
Node Biopsy ◽  
Pet Scanning ◽  
Pet Scans

8582 Background: Positron emission tomography (PET) scanning is increasingly used for the staging and management of malignant melanoma. The role of PET as a routine procedure in patients with positive sentinel node biopsy (SNB) is not yet established. We report in the series with longest follow up outcomes of PET scans performed in patients with subclinical lymph node disease. Methods: Case notes of 29 sequential patients with melanoma of Breslow thickness greater than 1mm who had PET scans within 130 days after a positive SNB were reviewed. Four patients had a PET after the lymph node dissection (LND). Results: 2 patients (6%) had a positive PET scan neither of which was melanoma related. The first patient had a thyroid tumour confirmed with fine needle aspiration biopsy and the second patient had increased uptake in the chest wall which on verification with bone scan proved to be old trauma. 28 patients (96%) had a LND and this was positive in 5 cases (17%). With a median follow up of 23 months 21 patients remained disease free. Out of the 8 patients (27%) who presented with recurrence 2 (25%) were successfully treated with further surgery and remained in remission, 4 (50%) died, 1 (12.5%) was lost from follow-up and 1 (12.5%) is followed up in another hospital. In none of the 29 cases did the early PET scan after a positive SNB alter subsequent melanoma management. Conclusions: The role of PET scanning soon after a positive sentinel node biopsy appears to be of uncertain benefit. It is questionable whether any imaging is beneficial at this stage. The results of this review suggest that PET scanning might not be indicated for this group of patients but larger prospective studies are required to confirm this. Patients Characteristics No % Male 15 (51) Female 14 (49) Melanoma Type: Nodular 8 (27) Superficial spreading 15 (51) Other 2 (6) Unknown 4 (13) Breslow thickness: 1.0–1.9 13 (44) 2.00–3.9 14 (49) ○= 4.0 2 (6) Ulceration: Yes 3 (10) No 25 (86) Unknown 1 (3) Age Median 56 No significant financial relationships to disclose.

Multidisciplinary treatment of 99 adult osteosarcoma (OST) patients (pts) with synchronous and metachronous metastases (mets): A retrospective series of the French Sarcoma Group (FSG).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11030-11030
Author(s):  
Elise Lavit ◽  
Mihaela Aldea ◽  
Nicolas Isambert ◽  
Jean-Emannuel Kurtz ◽  
Corinne Delcambre ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Prognostic Factors ◽  
Medical Records ◽  
Poor Prognosis ◽  
Multidisciplinary Treatment ◽  
Progression Free Survival ◽  
Surgical Removal ◽  
Free Survival ◽  
Adult Osteosarcoma

11030 Background: Treatment (trt) options for metastatic OST are scarce. Following failure of standard 1st line therapy pts who relapse present a challenging trt dilemma, and have poor prognosis. Surgical removal of all mets is essential. Currently, there are no standardized 2nd line trt options in relapsed OST. Methods: Pts were identified from 2 sarcoma databases; Netsarc and ConticaBase. Clinical data prospectively registered in the databases were supplemented with retrospective review of the medical records. Results: From January 2009 to December 2016, we identified 99 pts, in 12 FSG centers; 30 with synchronous (SC) and 69 with metachronous (MC) mets, with 62 males. Median age was 25 years (18-53). Total number of mets was 1 for 31 pts, 2-5 for 26 and > 5 for 42. Mets sites were lung, bone and other in 77, 14 and 22 pts respectively. Median time to first MC mets was 22 months (mo) (4-97). All pts except 10 with MC mets received a 1st line systemic trt for relapse, 65 a 2d-line, 38 a 3d-line, and 20 a 4th line, with 27 pts included in a clinical trial. Sixty five pts had local trt of distant mets (surgery for 54, irradiation for 5 and radioablation for 6). Eighteen pts had repeated thoracotomies (2 for 13 pts, 3 for 5, 1 for 1 pt). Nine of 10 MC mets pts (with ≤ 5mets) who never received any systemic trt had complete mets resection, 1 had mets radioablation, all were alive at last follow-up (FU). Median FU was 16.5 mo (2-132). Median progression free survival (PFS) and overall survival (OS) were 5.5 (95%CI 4-7) and 16.5 mo (95%CI 10-25) respectively. In multivariate analysis; > 5 mets, time to 1st mets < 24 mo, were negative prognostic factors on OS and PFS (p= 0.03, 0.01 and p=0.013, 0.00 respectively). Bone mets and absence of mets surgery were negative prognostic factors on OS only (with p=0.012, 0.008). Conclusions: Adult OST pts with distant mets are heterogeneous with poor prognosis. Complete surgery of distant mets remains essential. In reference sarcoma center, OST pts at relapse with > 1 mets commonly receive >1st line of systemic trt, and are included in clinical trial. Multidisciplinary trt combining complete mets local trt and systemic therapy seems to be rational.

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