Original article
Sentinel Lymph Node Biopsy in Patients With Melanoma
La técnica del ganglio centinela en pacientes con melanoma
L. Tomás-Mallebreraa, R. Rojo-Españaa, A. Marquina-Vilaa, N. Gimeno-Clementeb,c, M.M. Morales-Suárez-Varelab,c,d,
Corresponding author
a Servicio de Dermatología, Hospital Universitario Dr. Peset, Valencia, Spain
b CIBER Epidemiología y Salud Pública (CIBERESP), Spain
c Unidad de Salud Pública, Higiene y Sanidad Ambiental, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Spain
d Fundación de la Comunidad Valenciana para la Investigación, Hospital Universitario Dr. Peset, Valencia, Spain
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One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness ≥1mm, Breslow thickness <1mm with ulceration, Clark level IV–V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow thickness, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33–8.90); Breslow thickness >2.0, for a thickness of 2.1–4.0 (ORc, 21.12; 95% CI, 2.60–172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44–221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03–74.12); ulceration (ORc, 4.86; 95% CI, 1.58–14.90); T3 (ORc, 4.20; 95% CI, 1.52–11.63) and T4 (ORc, 4.67; 95% CI, 1.27–17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25–22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62–96.15).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Actualmente existe un aumento mundial de la incidencia de melanoma. Su pronóstico depende entre otros factores de la existencia de metástasis en los ganglios linfáticos regionales. La realización de la biopsia del ganglio centinela persigue la identificación de metástasis ganglionares subclínicas como factor pronóstico de la enfermedad. El presente estudio tiene por objetivo estudiar las diferencias entre los pacientes con melanoma, positivos y negativos a la biopsia del ganglio centinela, y analizar el impacto de esta técnica en su pronóstico.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow ≥ 1 mm o con Breslow < 1 mm y ulceración, nivel de Clark IV–V o regresión. Aquellos con biopsia positiva fueron sometidos a linfadenectomía. Además, se recogieron las siguientes variables: sexo, edad, fototipo, localización y tipo de melanoma, niveles Breslow y Clark, ulceración, regresión, estadio inicial, TNM, cambio de estadio y fallecimiento por melanoma.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 19,44% de los pacientes presentó ganglios positivos. Esta positividad se presentó asociada con el melanoma nodular (odds ratio cruda [ORc]: 3,44; intervalo de confianza al 95% [IC 95%]: 1,33–8,90) con respecto al melanoma de extensión superficial Breslow superior a 2,0 (nivel 2,1–4,0: ORc: 21,14; IC 95%: 2,60–172,03, nivel > 4,0: ORc: 23,25; IC 95%: 2,44–221,73), nivel Clark IV (ORc: 8,73; IC 95% 1,03–74,12), ulceración (ORc: 4,86; IC 95%: 1,58–14,90), estadios T3 y T4 (T3: ORc: 4,20; IC 95%: 1,52–11,63; T4: ORc: 4,67; IC 95% 1,27–17,15), cambio de estadio (ORc: 7,20; IC 95%: 2,25–22,99) y fallecimiento por melanoma (ORc: 8,67; IC 95%: 3,62–96,15).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estos resultados confirman la importancia pronóstica de la biopsia del ganglio centinela, que permite identificar a los pacientes con mayor tendencia a la progresión de la enfermedad y fallecimiento por melanoma.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of skin cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 10 | 18 |
| 2024 October | 59 | 60 | 119 |
| 2024 September | 56 | 44 | 100 |
| 2024 August | 100 | 60 | 160 |
| 2024 July | 62 | 40 | 102 |
| 2024 June | 58 | 40 | 98 |
| 2024 May | 57 | 43 | 100 |
| 2024 April | 67 | 23 | 90 |
| 2024 March | 63 | 38 | 101 |
| 2024 February | 51 | 45 | 96 |
| 2024 January | 37 | 40 | 77 |
| 2023 December | 51 | 33 | 84 |
| 2023 November | 55 | 35 | 90 |
| 2023 October | 46 | 33 | 79 |
| 2023 September | 42 | 36 | 78 |
| 2023 August | 25 | 16 | 41 |
| 2023 July | 28 | 64 | 92 |
| 2023 June | 40 | 35 | 75 |
| 2023 May | 36 | 43 | 79 |
| 2023 April | 26 | 22 | 48 |
| 2023 March | 36 | 26 | 62 |
| 2023 February | 36 | 33 | 69 |
| 2023 January | 27 | 39 | 66 |
| 2022 December | 39 | 48 | 87 |
| 2022 November | 18 | 25 | 43 |
| 2022 October | 25 | 15 | 40 |
| 2022 September | 20 | 37 | 57 |
| 2022 August | 22 | 43 | 65 |
| 2022 July | 15 | 35 | 50 |
| 2022 June | 24 | 32 | 56 |
| 2022 May | 30 | 49 | 79 |
| 2022 April | 37 | 38 | 75 |
| 2022 March | 36 | 55 | 91 |
| 2022 February | 21 | 32 | 53 |
| 2022 January | 20 | 50 | 70 |
| 2021 December | 41 | 47 | 88 |
| 2021 November | 29 | 51 | 80 |
| 2021 October | 28 | 56 | 84 |
| 2021 September | 23 | 57 | 80 |
| 2021 August | 30 | 43 | 73 |
| 2021 July | 18 | 35 | 53 |
| 2021 June | 27 | 48 | 75 |
| 2021 May | 33 | 39 | 72 |
| 2021 April | 58 | 50 | 108 |
| 2021 March | 77 | 37 | 114 |
| 2021 February | 62 | 29 | 91 |
| 2021 January | 34 | 26 | 60 |
| 2020 December | 31 | 15 | 46 |
| 2020 November | 22 | 36 | 58 |
| 2020 October | 20 | 16 | 36 |
| 2020 September | 20 | 12 | 32 |
| 2020 August | 30 | 26 | 56 |
| 2020 July | 28 | 13 | 41 |
| 2020 June | 30 | 33 | 63 |
| 2020 May | 20 | 23 | 43 |
| 2020 April | 22 | 30 | 52 |
| 2020 March | 18 | 24 | 42 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 0 | 11 | 11 |
| 2019 December | 0 | 5 | 5 |
| 2019 November | 0 | 1 | 1 |
| 2019 September | 0 | 2 | 2 |
| 2019 July | 0 | 1 | 1 |
| 2019 June | 0 | 5 | 5 |
| 2019 May | 1 | 41 | 42 |
| 2019 April | 0 | 7 | 7 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 0 | 3 | 3 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 13 | 4 | 17 |
| 2018 January | 14 | 2 | 16 |
| 2017 December | 21 | 7 | 28 |
| 2017 November | 14 | 4 | 18 |
| 2017 October | 12 | 3 | 15 |
| 2017 September | 16 | 4 | 20 |
| 2017 August | 25 | 7 | 32 |
| 2017 July | 16 | 3 | 19 |
| 2017 June | 21 | 8 | 29 |
| 2017 May | 16 | 6 | 22 |
| 2017 April | 15 | 2 | 17 |
| 2017 March | 16 | 4 | 20 |
| 2017 February | 14 | 9 | 23 |
| 2017 January | 19 | 1 | 20 |
| 2016 December | 18 | 14 | 32 |
| 2016 November | 13 | 7 | 20 |
| 2016 October | 9 | 20 | 29 |
| 2016 September | 16 | 10 | 26 |
| 2016 August | 30 | 4 | 34 |
| 2016 July | 25 | 4 | 29 |
| 2016 June | 10 | 0 | 10 |
| 2016 May | 8 | 5 | 13 |
| 2016 April | 7 | 0 | 7 |
| 2016 March | 10 | 0 | 10 |
| 2016 February | 2 | 2 | 4 |
| 2016 January | 7 | 1 | 8 |
| 2015 December | 10 | 2 | 12 |
| 2015 November | 4 | 0 | 4 |
| 2015 October | 8 | 1 | 9 |
| 2015 September | 8 | 4 | 12 |
| 2015 August | 13 | 4 | 17 |
| 2015 July | 28 | 12 | 40 |
| 2015 June | 28 | 9 | 37 |
| 2015 May | 58 | 15 | 73 |
| 2015 April | 36 | 10 | 46 |
| 2015 March | 49 | 8 | 57 |
| 2015 February | 20 | 6 | 26 |
| 2015 January | 18 | 12 | 30 |
| 2014 December | 13 | 5 | 18 |
| 2014 November | 11 | 4 | 15 |
| 2014 October | 29 | 13 | 42 |
| 2014 September | 20 | 7 | 27 |
| 2014 August | 30 | 20 | 50 |
| 2014 July | 36 | 25 | 61 |
| 2014 June | 49 | 6 | 55 |
| 2014 May | 35 | 16 | 51 |
| 2014 April | 29 | 8 | 37 |
| 2014 March | 39 | 21 | 60 |
| 2014 February | 19 | 17 | 36 |
| 2014 January | 34 | 12 | 46 |
| 2013 December | 26 | 11 | 37 |
| 2013 November | 19 | 13 | 32 |
| 2013 October | 20 | 17 | 37 |
| 2013 September | 31 | 14 | 45 |
| 2013 August | 13 | 19 | 32 |
| 2013 July | 23 | 23 | 46 |
| 2013 June | 19 | 22 | 41 |
| 2013 May | 14 | 18 | 32 |
| 2013 April | 25 | 15 | 40 |
| 2013 March | 27 | 18 | 45 |
| 2013 February | 11 | 10 | 21 |
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