title: Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma.
abstract: BACKGROUND
  The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable.
  
  
  METHODS
  We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database.
  
  
  RESULTS
  Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93 months), the incidence of FN-SNB was 2.8%. While calculated FN rate was 14.5% [84 FN/(494 TP + 84 FN) × 100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5% [46 FN/(494 TP + 46 FN) × 100 %]. On multivariate analysis, male gender (OR 2.0, 95% CI 1.1-3.6, p = 0.018), head/neck primaries (OR 2.5, 95% CI 1.3-4.8, p < 0.006), and LITR (OR 3.5, 95% CI 2.1-5.8, p < 0.001) were associated with FN-SNB. Melanoma-specific survival (MSS) for the FN group was similar to the TP group at 5 years (68 vs. 73%, p = 0.539). However, MSS declined more for the FN group with a longer follow up and was significantly worse at 10 years (44 vs. 64%, p < 0.001). On multivariate analysis, FN-SNB was a significant predictor of worse MSS in melanomas <4 mm in Breslow thickness (HR 1.6; 95% CI 1.1-2.5, p = 0.021).
  
  
  CONCLUSIONS
  Male gender, LITR, and head and neck tumors were associated with FN-SNB. FN-SNB was an independent predictor of worse MSS in melanomas <4 mm in thickness, but this survival difference did not become apparent until after 5 years of follow-up.
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Kelly T
authors.initials: KT
authors.lastname: Huynh
authors.affiliation: Department of Surgery, Mount Sinai, St-Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Teng
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Lau
authors.affiliation: Ochsner Clinical School, University of Queensland School of Medicine, Saint Lucia, QLD, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Vitug
authors.affiliation: Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Ji-Hey
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Stern
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Leland J
authors.initials: LJ
authors.lastname: Foshag
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA. mark.faries@jwci.org.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult