Impact of molecular staging methods in primary melanoma: reverse-transcriptase polymerase chain reaction (RT-PCR) of ultrasound-guided aspirate of the sentinel node does not improve diagnostic accuracy, but RT-PCR of peripheral blood does predict survival.
OBJECTIVE
This study analyzes (1) the value of tyrosinase reverse-transcriptase polymerase chain reaction (RT-PCR) of aspirates obtained by ultrasound-guided fine-needle aspiration cytology (US-FNAC) of sentinel nodes (SNs) in patients with melanoma before sentinel lymph node biopsy (SLNB) and (2) the value of RT-PCR of blood samples of all SLNB patients.


METHODS
Between 2001 and 2003, 127 patients with melanoma (median Breslow depth, 2.1 mm) underwent SLNB. FNAC was performed in all SNs of all patients pre- and post-SLNB. The aspirates were partly shock-frozen for RT-PCR and were partly used for standard cytology. Peripheral blood was collected at the time of SLNB and at every outpatient visit thereafter.


RESULTS
Thirty-four (23%) of 120 SNs were positive for melanoma. SN involvement was predicted by US-FNAC with a sensitivity of 82% and a specificity of 72%. Additional tyrosinase RT-PCR revealed the same sensitivity of 82% and a specificity of 72%. At a median follow-up time of 40 months from first blood sample, peripheral-blood RT-PCR was a significant independent predictor of disease-free survival (DFS) and overall survival (OS; P < .001).


CONCLUSIONS
US-FNAC is highly accurate and eliminates the need for SLNB in 16% of all SLNB patients. RT-PCR of the aspirate or excised SN does not improve sensitivity or specificity. RT-PCR of blood samples predicts DFS and OS.
Voit
Christiane A
CA
Department of Dermatology of the Charité, Humboldt University, Berlin, Germany. christiane.voit@t-online.de
Schäfer-Hesterberg
Gregor
G
Kron
Martina
M
van Akkooi
Alexander C J
AC
Rademaker
Juergen
J
Lukowsky
Ansgar
A
Schoengen
Alfred
A
Schwürzer-Voit
Markus
M
Sterry
Wolfram
W
Krause
Markus
M
Röwert-Huber
Joachim
J
Eggermont
Alexander M M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics*; D044963:Biopsy, Fine-Needle; D018572:Disease-Free Survival; D005260:Female; D015971:Gene Expression Regulation, Enzymologic; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000201:enzymology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000097:blood / Q000000981:diagnostic imaging / Q000201:enzymology / Q000235:genetics* / Q000628:therapy; D008875:Middle Aged; D014442:Monophenol Monooxygenase / Q000097:blood / Q000235:genetics*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
D014408:Biomarkers, Tumor; D014442:Monophenol Monooxygenase