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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of melanoma is currently increasing worldwide&#46; One of the factors influencing disease prognosis is the presence of regional lymph node metastases&#46; Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease&#46; 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&#46;</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&#58; Breslow thickness &#8805;1mm&#44; Breslow thickness &#60;1mm with ulceration&#44; Clark level IV&#8211;V&#44; or regression&#46; Lymphadenectomy was performed in patients with positive sentinel node biopsy&#46; Data were also collected on the following variables&#58; sex&#44; age&#44; skin phototype&#44; site and type of melanoma&#44; Breslow thickness&#44; Clark level&#44; ulceration&#44; regression&#44; cancer stage at diagnosis&#44; TNM classification&#44; change in cancer stage during follow-up&#44; and death due to melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive sentinel node biopsies were recorded in 19&#46;44&#37; of patients&#46; Positive results were associated with the following variables&#58; nodular melanoma &#40;crude odds ratio &#91;ORc&#93; compared with superficial spreading melanoma&#44; 3&#46;44&#59; 95&#37; confidence interval &#91;CI&#93;&#44; 1&#46;33&#8211;8&#46;90&#41;&#59; Breslow thickness &#62;2&#46;0&#44; for a thickness of 2&#46;1&#8211;4&#46;0 &#40;ORc&#44; 21&#46;12&#59; 95&#37; CI&#44; 2&#46;60&#8211;172&#46;03&#41; and for a thickness &#62;4&#46;0 &#40;ORc&#44; 23&#46;25&#59; 95&#37; CI&#44; 2&#46;44&#8211;221&#46;73&#41;&#59; Clark level IV &#40;ORc&#44; 8&#46;73&#59; 95&#37; CI&#44; 1&#46;03&#8211;74&#46;12&#41;&#59; ulceration &#40;ORc&#44; 4&#46;86&#59; 95&#37; CI&#44; 1&#46;58&#8211;14&#46;90&#41;&#59; T3 &#40;ORc&#44; 4&#46;20&#59; 95&#37; CI&#44; 1&#46;52&#8211;11&#46;63&#41; and T4 &#40;ORc&#44; 4&#46;67&#59; 95&#37; CI&#44; 1&#46;27&#8211;17&#46;15&#41; in the TNM classification&#59; change in cancer stage during follow-up &#40;ORc&#44; 7&#46;20&#59; 95&#37; CI&#44; 2&#46;25&#8211;22&#46;99&#41;&#59; and death due to melanoma &#40;ORc&#44; 8&#46;67&#59; 95&#37; CI&#44; 3&#46;62&#8211;96&#46;15&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These results confirm the prognostic importance of sentinel lymph node biopsy&#44; which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Actualmente existe un aumento mundial de la incidencia de melanoma&#46; Su pron&#243;stico depende entre otros factores de la existencia de met&#225;stasis en los ganglios linf&#225;ticos regionales&#46; La realizaci&#243;n de la biopsia del ganglio centinela persigue la identificaci&#243;n de met&#225;stasis ganglionares subcl&#237;nicas como factor pron&#243;stico de la enfermedad&#46; El presente estudio tiene por objetivo estudiar las diferencias entre los pacientes con melanoma&#44; positivos y negativos a la biopsia del ganglio centinela&#44; y analizar el impacto de esta t&#233;cnica en su pron&#243;stico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow &#8805; 1 mm o con Breslow &#60; 1 mm y ulceraci&#243;n&#44; nivel de Clark IV&#8211;V o regresi&#243;n&#46; Aquellos con biopsia positiva fueron sometidos a linfadenectom&#237;a&#46; Adem&#225;s&#44; se recogieron las siguientes variables&#58; sexo&#44; edad&#44; fototipo&#44; localizaci&#243;n y tipo de melanoma&#44; niveles Breslow y Clark&#44; ulceraci&#243;n&#44; regresi&#243;n&#44; estadio inicial&#44; TNM&#44; cambio de estadio y fallecimiento por melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 19&#44;44&#37; de los pacientes present&#243; ganglios positivos&#46; Esta positividad se present&#243; asociada con el melanoma nodular &#40;odds ratio cruda &#91;ORc&#93;&#58; 3&#44;44&#59; intervalo de confianza al 95&#37; &#91;IC 95&#37;&#93;&#58; 1&#44;33&#8211;8&#44;90&#41; con respecto al melanoma de extensi&#243;n superficial Breslow superior a 2&#44;0 &#40;nivel 2&#44;1&#8211;4&#44;0&#58; ORc&#58; 21&#44;14&#59; IC 95&#37;&#58; 2&#44;60&#8211;172&#44;03&#44; nivel &#62; 4&#44;0&#58; ORc&#58; 23&#44;25&#59; IC 95&#37;&#58; 2&#44;44&#8211;221&#44;73&#41;&#44; nivel Clark IV &#40;ORc&#58; 8&#44;73&#59; IC 95&#37; 1&#44;03&#8211;74&#44;12&#41;&#44; ulceraci&#243;n &#40;ORc&#58; 4&#44;86&#59; IC 95&#37;&#58; 1&#44;58&#8211;14&#44;90&#41;&#44; estadios T3 y T4 &#40;T3&#58; ORc&#58; 4&#44;20&#59; IC 95&#37;&#58; 1&#44;52&#8211;11&#44;63&#59; T4&#58; ORc&#58; 4&#44;67&#59; IC 95&#37; 1&#44;27&#8211;17&#44;15&#41;&#44; cambio de estadio &#40;ORc&#58; 7&#44;20&#59; IC 95&#37;&#58; 2&#44;25&#8211;22&#44;99&#41; y fallecimiento por melanoma &#40;ORc&#58; 8&#44;67&#59; IC 95&#37;&#58; 3&#44;62&#8211;96&#44;15&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estos resultados confirman la importancia pron&#243;stica de la biopsia del ganglio centinela&#44; que permite identificar a los pacientes con mayor tendencia a la progresi&#243;n de la enfermedad y fallecimiento por melanoma&#46;</p>"
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Vol. 101. Núm. 5.
Páginas 428-436 (junio - julio 2010)
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Vol. 101. Núm. 5.
Páginas 428-436 (junio - julio 2010)
Original article
Acceso a texto completo
Sentinel Lymph Node Biopsy in Patients With Melanoma
La técnica del ganglio centinela en pacientes con melanoma
Visitas
6012
L. Tomás-Mallebreraa, R. Rojo-Españaa, A. Marquina-Vilaa, N. Gimeno-Clementeb,c, M.M. Morales-Suárez-Varelab,c,d,
Autor para correspondencia
maria.m.morales@uv.es

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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Abstract
Introduction and objectives

The incidence of melanoma is currently increasing worldwide. 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.

Material and methods

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.

Results

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).

Conclusions

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.

Keywords:
Melanoma
Sentinel lymph node biopsy
Prognostic value
Resumen
Introducción y objetivos

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.

Material y métodos

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.

Resultados

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).

Conclusiones

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.

Palabras clave:
Melanoma
Biopsia del ganglio centinela
Valor pronóstico
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