title: Clinical considerations on sentinel node biopsy in melanoma from an Italian multicentric study on 1,313 patients (SOLISM-IMI).
abstract: BACKGROUND
  Although widely used for the management of patients with cutaneous melanoma, the sentinel lymph node (SLN) biopsy (SNB) procedure raises several issues. This study was designed to investigate: the predictive factors of SLN status, the false-negative (FN) rate, and patients' prognosis after SNB.
  
  
  METHODS
  This is an observational, prospective study conducted on a large series of consecutive patients (n = 1,313) enrolled by 23 Italian centers from 2000 through 2002. A commonly shared protocol was adopted for the SNB surgical procedure and the SLN pathological examination.
  
  
  RESULTS
  The SLN positive and false-negative (FN) rates were 16.9% and 14.4%, respectively (median follow-up, 4.5 years). At multivariable logistic regression analysis, the frequency of positive SLN increased with increasing Breslow thickness (p < 0.0001) and decreased in patients with melanoma regression (p = 0.024). At the multivariable Cox regression analysis, SLN status was the most important prognostic factor (hazards ratio (HR) = 3.08) for overall survival; the other statistically significant factors were sex, age, Breslow thickness, and Clark's level. Considering SLN and NSLN status, including FN cases, we identified four groups of patients with different prognoses. The 5-year overall survival of patients with positive SLNs was 71.3% in those with negative nonsentinel lymph nodes (NSLNs) and 50.4% if NSLNs were positive.
  
  
  CONCLUSIONS
  Regression in the primary melanoma seems to be a protective factor from metastasis in the SLN. When correctly calculated, the SNB FN rate is 15-20%. Furthermore, the SNB is important to more precisely assess the prognosis of patients with melanoma.
authors.affiliation: Melanoma and Sarcoma Division, European Institute of Oncology, Milano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Testori
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: De Salvo
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Montesco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trifirò
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Giorgio
authors.initials: G
authors.lastname: Landi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macripò
authors.forename: Paolo
authors.initials: P
authors.lastname: Carcoforo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giudice
authors.forename: Franco
authors.initials: F
authors.lastname: Picciotto
authors.forename: Davide
authors.initials: D
authors.lastname: Donner
authors.forename: Franco
authors.initials: F
authors.lastname: Di Filippo
authors.forename: Javier
authors.initials: J
authors.lastname: Soteldo
authors.forename: Dario
authors.initials: D
authors.lastname: Casara
authors.forename: Mauro
authors.initials: M
authors.lastname: Schiavon
authors.forename: Antonella
authors.initials: A
authors.lastname: Vecchiato
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.forename: Federica
authors.initials: F
authors.lastname: Baldini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mazzarol
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007558:Italy; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D055815:Young Adult