title: Factors associated with false-negative sentinel lymph node biopsy in melanoma patients.
abstract: BACKGROUND
  Some melanoma patients who undergo sentinel lymph node (SLN) biopsy will have false-negative (FN) results. We sought to determine the factors and outcomes associated with FN SLN biopsy.
  
  
  METHODS
  Analysis was performed of a prospective multi-institutional study that included patients with melanoma of thickness > 1.0 mm who underwent SLN biopsy. FN results were defined as the proportion of node-positive patients who had a tumor-negative sentinel node biopsy. Kaplan-Meier survival analysis and univariate and multivariate analyses were performed.
  
  
  RESULTS
  This analysis included 2,451 patients with median follow-up of 61 months. FN, true-positive (TP), and true-negative (TN) SLN results were found in 59 (10.8%), 486 (19.8%), and 1,906 (77.8%) patients, respectively. On univariate analysis comparing the FN with TP groups, respectively, the following factors were significantly different: age (52.6 vs. 47.6 years, p = 0.004), thickness (mean 2.1 vs. 3.1 mm, p = 0.003), lymphovascular invasion (LVI; 3.7 vs. 13.7%, p = 0.037), and local/in-transit recurrence (LITR; 32.2 vs. 12.4%, p < 0.0001); these factors remained significant on multivariate analysis. Overall 5-year survival was greater in the TN group (86.7%) compared with the TP (62.3%) and FN (51.3%) groups (p < 0.0001); however, there was no significant difference in overall survival comparing the TP and FN groups (p = 0.32).
  
  
  CONCLUSIONS
  This is the largest study to evaluate FN SLN results in melanoma, with a FN rate of 10.8%. FN results are associated with greater patient age, lower mean thickness, less frequent LVI, and greater risk of LITR. However, survival of patients with FN SLN is not statistically worse than that of patients with TP SLN.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA. charles.scoggins@nortonhealthcare.org
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Reintgen
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Urist
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: R
authors.initials: R
authors.lastname: Dirk Noyes
authors.forename: James S
authors.initials: JS
authors.lastname: Goydos
authors.forename: Peter D
authors.initials: PD
authors.lastname: Beitsch
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Hagendoorn
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult