title: The development of optimal pathological assessment of sentinel lymph nodes for melanoma.
abstract: 1158 sentinel lymph nodes (SLNs), excised from patients with primary cutaneous melanoma, were assessed pathologically using histology with immunohistochemistry (IHC) on all nodes, and RT-PCR for Mart-1 and tyrosinase on 55 nodes. RT-PCR was compared with the histology and IHC assessed on the same nodes. The evaluation of progressively more detailed protocols for histology and IHC modulated by the RT-PCR results led to a procedure that consistently detects metastases in 34% of patients submitted to SLN biopsy for cutaneous melanomas with a vertical growth phase and a mean thickness of 2.02 mm (range 0.25, with regression, to 19 mm). As this technique is virtually free of false positives and produces only a marginally lower detection rate than RT-PCR, which was subject to false positives of 7% in our study, it is suggested that this extended protocol should be the basis on which further evaluation of the place of RT-PCR in SLN assessment takes place. The evolved protocol described here has been adopted by the EORTC as the standard procedure for pathological handling of sentinel lymph nodes for melanoma when SLN status is a criterion in their clinical trials or studies.
authors.affiliation: Department of Histopathology, Royal Surrey County Hospital, Guildford, UK.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Cook
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Green
authors.forename: Brian
authors.initials: B
authors.lastname: Anderson
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Ruiter
authors.forename: Alain
authors.initials: A
authors.lastname: Spatz
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kissin
authors.forename: Barry W E M
authors.initials: BW
authors.lastname: Powell
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000556:secondary; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology*