Metastatic melanoma volume in sentinel nodes: objective stereology-based measurement predicts disease recurrence and survival

Aims:  Sentinel lymph node (SLN) status is the most important prognostic factor in intermediate thickness melanoma. The amount of metastatic disease in positive SLNs varies greatly between patients, and this tumour burden appears to influence the prognosis of node‐positive patients. The aim was to u...

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Bibliographic Details
Published in:Histopathology 2009-06, Vol.54 (7), p.796-803
Main Authors: Riber-Hansen, Rikke, Nyengaard, Jens R, Hamilton-Dutoit, Stephen J, Sjoegren, Pia, Steiniche, Torben
Format: Article
Language:English
Subjects:
Biological and medical sciences
Denmark - epidemiology
Dermatology
Disease-Free Survival
Female
Humans
Image Processing, Computer-Assisted
Investigative techniques, diagnostic techniques (general aspects)
Kaplan-Meier Estimate
Lymphatic Metastasis - pathology
Male
Medical sciences
melanoma
Melanoma - mortality
Melanoma - pathology
Melanoma - secondary
Middle Aged
neoplasm metastasis
pathology
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Recurrence
Sentinel Lymph Node Biopsy
stereology
Tumors of the skin and soft tissue. Premalignant lesions
tumour burden
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Summary:Aims:  Sentinel lymph node (SLN) status is the most important prognostic factor in intermediate thickness melanoma. The amount of metastatic disease in positive SLNs varies greatly between patients, and this tumour burden appears to influence the prognosis of node‐positive patients. The aim was to use objective stereological techniques to correlate accurately total SLN tumour burden with recurrence and patient survival. Methods and results:  SLNs from 327 patients were examined by complete step sectioning and immunohistochemistry. The total metastasis volume (TMV) of 156 positive SLNs from 99 patients (30.3%) was measured using stereological methods based on the 2D‐nucleator and Cavalieri’s principle. The maximum metastasis diameter was also measured. These two measurements were correlated with disease recurrence and patient survival. The mean TMV for SLN+ patients was 10.5 mm3 (median 0.05 mm3; range 0.0001–623.7 mm3). Median follow‐up was 26.3 months. On multivariate analysis, TMV was an independent predictor of recurrence when corrected for primary tumour thickness (P = 0.001) and was a stronger prognosticator compared with the maximum metastasis diameter (P 
ISSN:0309-0167
1365-2559
DOI:10.1111/j.1365-2559.2009.03312.x