Accuracy of the non-sentinel node risk score (N-SNORE) in patients with cutaneous melanoma and positive sentinel lymph nodes: a retrospective study.
BACKGROUND
Sentinel node (SLN) biopsy in patients with melanoma permits identification of those at risk for further metastases in non-sentinel lymph nodes (NSLN). However, a mere 20% of SLN-positive patients have metastases in NSLN. Therefore we need criteria to predict NSLN-positivity. A new score system known as the non-sentinel risk score, (N-SNORE) based on five clinical and pathological characteristics (gender, regression in primary melanoma, proportion of SNs containing melanoma, perinodal lymphatic invasion, and SN tumor burden), was first published in 2010. In this study, the accuracy of N-SNORE was validated in melanoma patients with positive SLN.


METHODS
A total of 106 melanoma patients with positive SLN, who had undergone complete lymph node dissection (CLND) subsequently, were included in the study. The N-SNORE was calculated in all patients, and the risk was compared to the frequency of NSLN metastases. Statistical analysis of the data was performed.


RESULTS
Thirteen patients were at very low risk for NSN metastasis (score 0), 63 patients at low risk (score 1-3), 19 at intermediate risk (score 4-5), 6 at high risk (score 6-7), and 5 at very high risk (score >8). NSLN positivity rates for these 5 risk groups were 7.7%, 18.2%, 21.1%, 33.3%, and 80%, respectively. According to Fisher's exact test, the contingency coefficient was .322; the p-value was .025.


CONCLUSIONS
An increasing N-SNORE was clearly correlated with a higher risk of NSLN positivity. Based on the p-value and the contingency coefficient, the overall accuracy of the N-SNORE was proven on statistical calculation.
Department of Dermatology, Krankenhaus Hietzing, Wolkersbergenstrasse 1, 1130 Vienna, Austria. Electronic address: robert.feldmann@wienkav.at.
R
R
Feldmann
Department of Dermatology, Wilhelminenspital, Montleartstraße 37, 1160 Vienna, Austria.
A M
AM
Fink
Department of Dermatology, Wilhelminenspital, Montleartstraße 37, 1160 Vienna, Austria.
W
W
Jurecka
Department of Dermatology, Krankenhaus Rudolfstiftung, Juchgasse 25, 1030 Vienna, Austria.
K
K
Rappersberger
Department of Dermatology, Krankenhaus Hietzing, Wolkersbergenstrasse 1, 1130 Vienna, Austria.
A
A
Steiner
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery
CLND; Melanoma; N-SNORE; Sentinel lymph node