title: Sentinel node biopsy for head and neck melanoma: a systematic review.
abstract: OBJECTIVE
  This systematic review was conducted to examine the test performance of sentinel node biopsy in head and neck melanoma, including the identification rate and false-negative rate.
  
  
  METHODS
  PubMed, EMBASE, ASCO, and SSO database searches were conducted to identify studies fulfilling the following inclusion criteria: sentinel node biopsy was performed, lesions were located on the head and neck, and recurrence data for both metastatic and nonmetastatic patients were reported.
  
  
  METHODS
  Dual-blind data extraction was conducted. Primary outcomes included identification rate and test performance based on completion neck dissection or nodal recurrence.
  
  
  RESULTS
  A total of 3442 patients from 32 studies published between 1990 and 2009 were reviewed. Seventy-eight percent of studies were retrospective and 22% were prospective. Trials varied from 9 to 755 patients (median 55). Mean Breslow depth was 2.53 mm. Median sentinel node biopsy identification rate was 95.2%. More than 1 basin was reported in 33.1% of patients. A median of 2.56 sentinel nodes per patient were excised. Sentinel node biopsy was positive in 15% of patients. Subsequent completion neck dissection was performed in almost all of these patients and revealed additional positive nodes in 13.67%. Median follow-up was 31 months. Across all studies, predictive value positive for nodal recurrence was 13.1% and posttest probability negative was 5%. Median false-negative rate for nodal recurrence was 20.4%.
  
  
  CONCLUSIONS
  Sentinel node biopsy of head and neck melanoma is associated with an increased false-negative rate compared with studies of non-head and neck lesions. Positive sentinel node status is highly predictive of recurrence.
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: de Rosa
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Damian
authors.initials: D
authors.lastname: Silbermins
authors.forename: Matias E
authors.initials: ME
authors.lastname: Valsecchi
authors.forename: Scott K
authors.initials: SK
authors.lastname: Pruitt
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Tyler
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis