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,
Autor para correspondencia
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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 11 | 20 |
| 2024 Octubre | 59 | 60 | 119 |
| 2024 Septiembre | 56 | 44 | 100 |
| 2024 Agosto | 100 | 60 | 160 |
| 2024 Julio | 62 | 40 | 102 |
| 2024 Junio | 58 | 40 | 98 |
| 2024 Mayo | 57 | 43 | 100 |
| 2024 Abril | 67 | 23 | 90 |
| 2024 Marzo | 63 | 38 | 101 |
| 2024 Febrero | 51 | 45 | 96 |
| 2024 Enero | 37 | 40 | 77 |
| 2023 Diciembre | 51 | 33 | 84 |
| 2023 Noviembre | 55 | 35 | 90 |
| 2023 Octubre | 46 | 33 | 79 |
| 2023 Septiembre | 42 | 36 | 78 |
| 2023 Agosto | 25 | 16 | 41 |
| 2023 Julio | 28 | 64 | 92 |
| 2023 Junio | 40 | 35 | 75 |
| 2023 Mayo | 36 | 43 | 79 |
| 2023 Abril | 26 | 22 | 48 |
| 2023 Marzo | 36 | 26 | 62 |
| 2023 Febrero | 36 | 33 | 69 |
| 2023 Enero | 27 | 39 | 66 |
| 2022 Diciembre | 39 | 48 | 87 |
| 2022 Noviembre | 18 | 25 | 43 |
| 2022 Octubre | 25 | 15 | 40 |
| 2022 Septiembre | 20 | 37 | 57 |
| 2022 Agosto | 22 | 43 | 65 |
| 2022 Julio | 15 | 35 | 50 |
| 2022 Junio | 24 | 32 | 56 |
| 2022 Mayo | 30 | 49 | 79 |
| 2022 Abril | 37 | 38 | 75 |
| 2022 Marzo | 36 | 55 | 91 |
| 2022 Febrero | 21 | 32 | 53 |
| 2022 Enero | 20 | 50 | 70 |
| 2021 Diciembre | 41 | 47 | 88 |
| 2021 Noviembre | 29 | 51 | 80 |
| 2021 Octubre | 28 | 56 | 84 |
| 2021 Septiembre | 23 | 57 | 80 |
| 2021 Agosto | 30 | 43 | 73 |
| 2021 Julio | 18 | 35 | 53 |
| 2021 Junio | 27 | 48 | 75 |
| 2021 Mayo | 33 | 39 | 72 |
| 2021 Abril | 58 | 50 | 108 |
| 2021 Marzo | 77 | 37 | 114 |
| 2021 Febrero | 62 | 29 | 91 |
| 2021 Enero | 34 | 26 | 60 |
| 2020 Diciembre | 31 | 15 | 46 |
| 2020 Noviembre | 22 | 36 | 58 |
| 2020 Octubre | 20 | 16 | 36 |
| 2020 Septiembre | 20 | 12 | 32 |
| 2020 Agosto | 30 | 26 | 56 |
| 2020 Julio | 28 | 13 | 41 |
| 2020 Junio | 30 | 33 | 63 |
| 2020 Mayo | 20 | 23 | 43 |
| 2020 Abril | 22 | 30 | 52 |
| 2020 Marzo | 18 | 24 | 42 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 0 | 11 | 11 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 2 | 2 |
| 2019 Julio | 0 | 1 | 1 |
| 2019 Junio | 0 | 5 | 5 |
| 2019 Mayo | 1 | 41 | 42 |
| 2019 Abril | 0 | 7 | 7 |
| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 0 | 3 | 3 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 13 | 4 | 17 |
| 2018 Enero | 14 | 2 | 16 |
| 2017 Diciembre | 21 | 7 | 28 |
| 2017 Noviembre | 14 | 4 | 18 |
| 2017 Octubre | 12 | 3 | 15 |
| 2017 Septiembre | 16 | 4 | 20 |
| 2017 Agosto | 25 | 7 | 32 |
| 2017 Julio | 16 | 3 | 19 |
| 2017 Junio | 21 | 8 | 29 |
| 2017 Mayo | 16 | 6 | 22 |
| 2017 Abril | 15 | 2 | 17 |
| 2017 Marzo | 16 | 4 | 20 |
| 2017 Febrero | 14 | 9 | 23 |
| 2017 Enero | 19 | 1 | 20 |
| 2016 Diciembre | 18 | 14 | 32 |
| 2016 Noviembre | 13 | 7 | 20 |
| 2016 Octubre | 9 | 20 | 29 |
| 2016 Septiembre | 16 | 10 | 26 |
| 2016 Agosto | 30 | 4 | 34 |
| 2016 Julio | 25 | 4 | 29 |
| 2016 Junio | 10 | 0 | 10 |
| 2016 Mayo | 8 | 5 | 13 |
| 2016 Abril | 7 | 0 | 7 |
| 2016 Marzo | 10 | 0 | 10 |
| 2016 Febrero | 2 | 2 | 4 |
| 2016 Enero | 7 | 1 | 8 |
| 2015 Diciembre | 10 | 2 | 12 |
| 2015 Noviembre | 4 | 0 | 4 |
| 2015 Octubre | 8 | 1 | 9 |
| 2015 Septiembre | 8 | 4 | 12 |
| 2015 Agosto | 13 | 4 | 17 |
| 2015 Julio | 28 | 12 | 40 |
| 2015 Junio | 28 | 9 | 37 |
| 2015 Mayo | 58 | 15 | 73 |
| 2015 Abril | 36 | 10 | 46 |
| 2015 Marzo | 49 | 8 | 57 |
| 2015 Febrero | 20 | 6 | 26 |
| 2015 Enero | 18 | 12 | 30 |
| 2014 Diciembre | 13 | 5 | 18 |
| 2014 Noviembre | 11 | 4 | 15 |
| 2014 Octubre | 29 | 13 | 42 |
| 2014 Septiembre | 20 | 7 | 27 |
| 2014 Agosto | 30 | 20 | 50 |
| 2014 Julio | 36 | 25 | 61 |
| 2014 Junio | 49 | 6 | 55 |
| 2014 Mayo | 35 | 16 | 51 |
| 2014 Abril | 29 | 8 | 37 |
| 2014 Marzo | 39 | 21 | 60 |
| 2014 Febrero | 19 | 17 | 36 |
| 2014 Enero | 34 | 12 | 46 |
| 2013 Diciembre | 26 | 11 | 37 |
| 2013 Noviembre | 19 | 13 | 32 |
| 2013 Octubre | 20 | 17 | 37 |
| 2013 Septiembre | 31 | 14 | 45 |
| 2013 Agosto | 13 | 19 | 32 |
| 2013 Julio | 23 | 23 | 46 |
| 2013 Junio | 19 | 22 | 41 |
| 2013 Mayo | 14 | 18 | 32 |
| 2013 Abril | 25 | 15 | 40 |
| 2013 Marzo | 27 | 18 | 45 |
| 2013 Febrero | 11 | 10 | 21 |
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