Chest X-ray Prior to Sentinel Lymph Node Biopsy May Not Be Useful in Initial Staging of Primary Melanoma: Presented at ESSO

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Title: Chest X-ray Prior to Sentinel Lymph Node Biopsy May Not Be Useful in Initial Staging of Primary Melanoma: Presented at ESSO
URL: http://www.pslgroup.com/dg/22C5F2.htm
Doctor's Guide
September 15, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 15, 2008 -- Chest x-ray prior to sentinel-lymph-node biopsy is not useful in detecting possible lung metastases and has no impact on treatment strategies in patients with primary melanoma, researchers reported here at the 14th Congress of the European Society of Surgical Oncology (ESSO).

Chest x-rays are sometimes performed in patients with primary melanoma to look for pulmonary metastases, in which case sentinel-node biopsy or completion lymph-node dissection might be avoided, according to Dr. Vermeeren.

"Chest x-ray probably should have no role in the routine work-up of patients with primary melanoma," said lead author Lenka Vermeeren, MD, Department of Surgery, Maasland Hospital, Sittard, The Netherlands.

Dr. Vermeeren presented the results of a prospective database study on September 12.

For their study, Dr. Vermeeren and colleagues evaluated the records of 248 patients diagnosed with primary cutaneous melanoma between January 1994 and August 2007 and who had an indication for undergoing sentinel-node biopsy. If a chest x-ray was done, it was carried out before the biopsy.

Patients were a mean of 51 years old and the cohort had equal numbers of women and men.

A chest x-ray was carried out in 227 patients (91.5%), 19 patients (7.7%) underwent no initial radiological staging, and 2 patients (0.8%) had only a computed tomography (CT) scan of the chest. Chest imaging was performed in all 31 patients who had a thick melanoma (Breslow thickness >4 mm).

All patients underwent sentinel-node biopsy and 23.7% of these patients were found to be tumour-positive.

According to the study findings, chest x-ray showed no metastasis in 216 patients (95%) and was inconclusive in 11 patients (5%). Six of these 11 patients underwent a chest CT scan, but no pulmonary metastases were seen. A possible liver lesion was seen on CT in 1 of the 6 patients, and further investigation confirmed this to be a hepatic metastasis. In the other 5 patients, regular follow-up examinations were carried out, and no pulmonary metastases were found during a follow-up period of 5 years or longer. In other words, these 11 cases were found to be false-positive.

In this study of patients with primary melanoma, "preoperative chest x-ray had no consequences on therapeutic strategy," Dr. Vermeeren concluded.

[Presentation title: Initial Staging With Chest X-ray Before Sentinel Node Procedure in Patients With Primary Melanoma. Abstract 182]

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