title: Prognostic value of sentinel lymph node biopsy compared with that of Breslow thickness: implications for informed consent in patients with invasive melanoma.
abstract: BACKGROUND
  Sentinel lymph node (SLN) status is reportedly a powerful prognosticator of survival. Breslow thickness alone provides significant prognostic information.
  
  
  OBJECTIVE
  To assess overall survival (OS) according to tumor depth based on SLN status.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Central Database were searched for studies. Included studies evaluated overall survival according to SLNB results and were stratified according to Breslow thickness. Meta-analysis was performed if appropriate in each category for which three or more studies reported risk estimates and variability measurement.
  
  
  RESULTS
  Twenty-nine articles met inclusion criteria. Six met the criteria for meta-analysis. In individuals with thin melanoma (<1 mm), SLN-negative status conferred no survival advantage (sign test, p > .99). Few studies were available for intermediate depths, and most reported worse survival in SLN-positive patients, although the difference was not statistically significant (p > .05). For thick melanoma (>4 mm), SLN positivity was related to worse prognosis (sign test, p = .004). Based on the pooled results of six studies of patients with tumors 4 mm thick or thicker, SLN-positive patients had a greater likelihood of dying (hazard ratio = 2.42, 95% confidence interval = 2.00-2.92).
  
  
  CONCLUSIONS
  Sentinel lymph node biopsy may not provide more-accurate prognostic information than Breslow thickness for most melanomas.
authors.affiliation: Shadyside Medical Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Freeman
authors.forename: Bethany B
authors.initials: BB
authors.lastname: Gibbs
authors.forename: David G
authors.initials: DG
authors.lastname: Brodland
authors.forename: John A
authors.initials: JA
authors.lastname: Zitelli
mesh_terms: D006801:Humans; D007258:Informed Consent; D008545:Melanoma / Q000473:pathology*; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate