USF-LVHN SELECT
Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma.
Publication/Presentation Date
11-1-2021
Abstract
BACKGROUND: Sentinel lymph node biopsy (SLNB) is routinely recommended for clinically localized Merkel cell carcinoma (MCC); however, predictors of false negative (FN) SLNB are undefined.
METHODS: Patients from six centers undergoing wide excision and SLNB for stage I/II MCC (2005-2020) were identified and were classified as having either a true positive (TP), true negative (TN) or FN SLNB. Predictors of FN SLNB were identified and survival outcomes were estimated.
RESULTS: Of 525 patients, 28 (5.4%), 329 (62.7%), and 168 (32%) were classified as FN, TN, and TP, respectively, giving an FN rate of 14.3% and negative predictive value of 92.2% for SLNB. Median follow-up for SLNB-negative patients was 27 months, and median time to nodal recurrence for FN patients was 7 months. Male sex (hazard ratio [HR] 3.15, p = 0.034) and lymphovascular invasion (LVI) (HR 2.22, p = 0.048) significantly correlated with FN, and increasing age trended toward significance (HR 1.04, p = 0.067). The 3-year regional nodal recurrence-free survival for males >75 years with LVI was 78.5% versus 97.4% for females ≤75 years without LVI (p = 0.009). Five-year disease-specific survival (90.9% TN vs. 51.3% FN, p < 0.001) and overall survival (69.9% TN vs. 48.1% FN, p = 0.035) were significantly worse for FN patients.
CONCLUSION: Failure to detect regional nodal microscopic disease by SLNB is associated with worse survival in clinically localized MCC. Males, patients >75 years, and those with LVI may be at increased risk for FN SLNB. Consideration of increased nodal surveillance following negative SLNB in these high-risk patients may aid in early identification of regional nodal recurrences.
Volume
28
Issue
12
First Page
6995
Last Page
7003
ISSN
1534-4681
Published In/Presented At
Straker, R. J., 3rd, Carr, M. J., Sinnamon, A. J., Shannon, A. B., Sun, J., Landa, K., Baecher, K. M., Wood, C., Lynch, K., Bartels, H. G., Panchaud, R., Lowe, M. C., Slingluff, C. L., Jameson, M. J., Tsai, K., Faries, M. B., Beasley, G. M., Sondak, V., Karakousis, G. C., Zager, J. S., … Miura, J. T. (2021). Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma. Annals of surgical oncology, 28(12), 6995–7003. https://doi.org/10.1245/s10434-021-10031-z
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
33890195
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article