Impact of molecular staging methods in primary melanoma
reverse-transcriptase polymerase chain reaction (RT-PCR) of ultrasound-guided aspirate of the sentinel node does not improve diagnostic accuracy, but RT-PCR of peripheral blood does predict survival
PURPOSE: This study analyzes (1) the value of tyrosinase reverse-transcriptase polymerase chain reaction (RT-PCR) of aspirates obtained by ultrasound-guided fine-needle aspiration cytology (US-FNAC) of sentinel nodes (SNs) in patients with melanoma before sentinel lymph node biopsy (SLNB) and (2) the value of RT-PCR of blood samples of all SLNB patients. PATIENTS AND METHODS: Between 2001 and 2003, 127 patients with melanoma (median Breslow depth, 2.1 mm) underwent SLNB. FNAC was performed in all SNs of all patients pre- and post-SLNB. The aspirates were partly shock-frozen for RT-PCR and were partly used for standard cytology. Peripheral blood was collected at the time of SLNB and at every outpatient visit thereafter. RESULTS: Thirty-four (23%) of 120 SNs were positive for melanoma. SN involvement was predicted by US-FNAC with a sensitivity of 82% and a specificity of 72%. Additional tyrosinase RT-PCR revealed the same sensitivity of 82% and a specificity of 72%. At a median follow-up time of 40 months from first blood sample, peripheral-blood RT-PCR was a significant independent predictor of disease-free survival (DFS) and overall survival (OS; P < .001). CONCLUSION: US-FNAC is highly accurate and eliminates the need for SLNB in 16% of all SLNB patients. RT-PCR of the aspirate or excised SN does not improve sensitivity or specificity. RT-PCR of blood samples predicts DFS and OS.
|Keywords||*Biopsy, Fine-Needle, *Reverse Transcriptase Polymerase Chain Reaction, *Sentinel Lymph Node Biopsy, *Ultrasonography, Interventional, Adult, Aged, Aged, 80 and over, Disease-Free Survival, Female, Gene Expression Regulation, Enzymologic, Gene Expression Regulation, Neoplastic, Humans, Lymph Nodes/*enzymology/ultrasonography, Lymphatic Metastasis, Male, Melanoma/blood/enzymology/*genetics/therapy/ultrasonography, Middle Aged, Monophenol Monooxygenase/blood/*genetics, Neoplasm Staging, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Survival Analysis, Treatment Outcome, Tumor Markers, Biological/blood/*genetics, Young Adult|
|Persistent URL||dx.doi.org/10.1200/JCO.2007.13.7653, hdl.handle.net/1765/14941|
|Journal||Journal of Clinical Oncology|
Voit, C, Schäfer-Hesterberg, G, Kron, M, van Akkooi, A.C.J, Rademaker, J, Lukowsky, A, … Eggermont, A.M.M. (2008). Impact of molecular staging methods in primary melanoma. Journal of Clinical Oncology, 26(35), 5742–5747. doi:10.1200/JCO.2007.13.7653