Publication year: 2011
Source: European Journal of Cancer, Available online 22 October 2011
Rikke Riber-Hansen, Nina Hastrup, Ole Clemmensen, Nille Behrendt, Siri Klausen, ...
AimMetastasis size in melanoma sentinel lymph nodes (SLNs) is an emerging prognostic factor. Two European melanoma treatment trials include SLN metastasis diameters as inclusion criteria. Whilst diameter estimates are sensitive to the number of sections examined, the level of this bias is largely unknown. We performed a prospective multicentre study to compare the European Organisation for Research and Treatment of Cancer (EORTC) recommended protocol with a protocol of complete step-sectioning.MethodsOne hundred and thirty-three consecutive SLNs from seven SLN centres were analysed by five central sections 50 μm apart (EORTC Protocol) followed by complete 250 μm step-sectioning.ResultsOverall, 29 patients (21.8%) were SLN-positive. TheEORTC Protocolmissed eight of these metastases (28%), one metastasis measuring less than 0.1 mm in diameter, seven measuring between 0.1 and 1 mm. Complete step-sectioning at 250 μm intervals (Extensive Protocol) missed one metastasis (3%) that measured less than 0.1 mm. Thirteen treatment courses (34%) performed if inclusion was based on theCombined Protocolwould not be performed if assessed by theEORTC Protocol. Thus, 10 patients would be without completion lymph node dissection (EORTC MINITUB study), whilst three patients would not be eligible for anti-CTLA4 trial (EORTC protocol 18071). The corresponding number with theExtensive Protocolwould be three; one patient for the MINITUB registration study and two patients for the anti-CTLA4 study.ConclusionsExamining SLNs by close central sectioning alone (EORTC Protocol) misses a substantial number of metastases and underestimates the maximum metastasis diameter, leading to important changes in patient eligibility for various treatment protocols.
Source: European Journal of Cancer, Available online 22 October 2011
Rikke Riber-Hansen, Nina Hastrup, Ole Clemmensen, Nille Behrendt, Siri Klausen, ...
AimMetastasis size in melanoma sentinel lymph nodes (SLNs) is an emerging prognostic factor. Two European melanoma treatment trials include SLN metastasis diameters as inclusion criteria. Whilst diameter estimates are sensitive to the number of sections examined, the level of this bias is largely unknown. We performed a prospective multicentre study to compare the European Organisation for Research and Treatment of Cancer (EORTC) recommended protocol with a protocol of complete step-sectioning.MethodsOne hundred and thirty-three consecutive SLNs from seven SLN centres were analysed by five central sections 50 μm apart (EORTC Protocol) followed by complete 250 μm step-sectioning.ResultsOverall, 29 patients (21.8%) were SLN-positive. TheEORTC Protocolmissed eight of these metastases (28%), one metastasis measuring less than 0.1 mm in diameter, seven measuring between 0.1 and 1 mm. Complete step-sectioning at 250 μm intervals (Extensive Protocol) missed one metastasis (3%) that measured less than 0.1 mm. Thirteen treatment courses (34%) performed if inclusion was based on theCombined Protocolwould not be performed if assessed by theEORTC Protocol. Thus, 10 patients would be without completion lymph node dissection (EORTC MINITUB study), whilst three patients would not be eligible for anti-CTLA4 trial (EORTC protocol 18071). The corresponding number with theExtensive Protocolwould be three; one patient for the MINITUB registration study and two patients for the anti-CTLA4 study.ConclusionsExamining SLNs by close central sectioning alone (EORTC Protocol) misses a substantial number of metastases and underestimates the maximum metastasis diameter, leading to important changes in patient eligibility for various treatment protocols.
Sent with MobileRSS for iPhone
No comments:
Post a Comment