OBJECTIVE: To determine (1) the reliability of sentinel lymph node (SLN) biopsy and (2) the need for cytokeratin 20 (CK-20) immunostaining in the staging of head and neck Merkel cell carcinoma (MCC). DESIGN: Retrospective cohort study (median follow-up of 34.5 months). SETTING: Tertiary care center. PATIENTS: Ten patients with head and neck MCC who underwent regional staging with SLN biopsy (SLNB) and CK-20 immunostaining. INTERVENTIONS: Sentinel lymph nodes were identified using preoperative lymphoscintigraphy, intraoperative gamma probe, and isosulfan blue dye. The SLNs were evaluated with hematoxylin-eosin and CK-20 immunostaining. Patients with negative SLNB results were followed up clinically. MAIN OUTCOME MEASURES: Percentage of positive SLNs, regional recurrence in the setting of a negative finding from SLNB, and percentage of positive SLNs requiring CK-20 immunostaining for diagnosis of micrometastatic MCC. RESULTS: At least 1 SLN was identified in every patient. Of 24 nodes, 19 (79%) were from the neck region and 5 (21%) were from the parotid basin. Two of the 24 SLNs, in 2 (20%) of 10 patients, were positive for metastatic disease. Both positive SLNs appeared negative on hematoxylin-eosin-stained sections, but small foci of micrometastatic MCC were identified with CK-20 immunostaining. No cranial nerve complications occurred. Regional failure in the setting of a negative finding on SLNB was observed in 1 (12%) of 8 patients. CONCLUSIONS: Biopsy of SLNs represents a safe and reliable technique for regional staging of MCC of the head and neck. It provides pathologists with a limited number of SLNs for focused analysis, which is imperative because hematoxylin-eosin immunostaining is often insufficient for identifying micrometastatic MCC. The use of anti-CK-20 antibody allows accurate identification of micrometastatic MCC.
OBJECTIVE: To determine (1) the reliability of sentinel lymph node (SLN) biopsy and (2) the need for cytokeratin 20 (CK-20) immunostaining in the staging of head and neck Merkel cell carcinoma (MCC). DESIGN: Retrospective cohort study (median follow-up of 34.5 months). SETTING: Tertiary care center. PATIENTS: Ten patients with head and neck MCC who underwent regional staging with SLN biopsy (SLNB) and CK-20 immunostaining. INTERVENTIONS: Sentinel lymph nodes were identified using preoperative lymphoscintigraphy, intraoperative gamma probe, and isosulfan blue dye. The SLNs were evaluated with hematoxylin-eosin and CK-20 immunostaining. Patients with negative SLNB results were followed up clinically. MAIN OUTCOME MEASURES: Percentage of positive SLNs, regional recurrence in the setting of a negative finding from SLNB, and percentage of positive SLNs requiring CK-20 immunostaining for diagnosis of micrometastatic MCC. RESULTS: At least 1 SLN was identified in every patient. Of 24 nodes, 19 (79%) were from the neck region and 5 (21%) were from the parotid basin. Two of the 24 SLNs, in 2 (20%) of 10 patients, were positive for metastatic disease. Both positive SLNs appeared negative on hematoxylin-eosin-stained sections, but small foci of micrometastatic MCC were identified with CK-20 immunostaining. No cranial nerve complications occurred. Regional failure in the setting of a negative finding on SLNB was observed in 1 (12%) of 8 patients. CONCLUSIONS: Biopsy of SLNs represents a safe and reliable technique for regional staging of MCC of the head and neck. It provides pathologists with a limited number of SLNs for focused analysis, which is imperative because hematoxylin-eosin immunostaining is often insufficient for identifying micrometastatic MCC. The use of anti-CK-20 antibody allows accurate identification of micrometastatic MCC.
Authors: Stephen P Povoski; Ryan L Neff; Cathy M Mojzisik; David M O'Malley; George H Hinkle; Nathan C Hall; Douglas A Murrey; Michael V Knopp; Edward W Martin Journal: World J Surg Oncol Date: 2009-01-27 Impact factor: 2.754
Authors: Stanley J Miller; Murad Alam; James Andersen; Daniel Berg; Christopher K Bichakjian; Glen Bowen; Richard T Cheney; L Frank Glass; Roy C Grekin; Dennis E Hallahan; Anne Kessinger; Nancy Y Lee; Nanette Liegeois; Daniel D Lydiatt; Jeff Michalski; William H Morrison; Kishwer S Nehal; Kelly C Nelson; Paul Nghiem; Thomas Olencki; Allan R Oseroff; Clifford S Perlis; E William Rosenberg; Ashok R Shaha; Marshall M Urist; Linda C Wang Journal: J Natl Compr Canc Netw Date: 2009-03 Impact factor: 12.693
Authors: Christopher K Bichakjian; Thomas Olencki; Murad Alam; James S Andersen; Daniel Berg; Glen M Bowen; Richard T Cheney; Gregory A Daniels; L Frank Glass; Roy C Grekin; Kenneth Grossman; Alan L Ho; Karl D Lewis; Daniel D Lydiatt; William H Morrison; Kishwer S Nehal; Kelly C Nelson; Paul Nghiem; Clifford S Perlis; Ashok R Shaha; Wade L Thorstad; Malika Tuli; Marshall M Urist; Timothy S Wang; Andrew E Werchniak; Sandra L Wong; John A Zic; Karin G Hoffmann; Nicole R McMillian; Maria Ho Journal: J Natl Compr Canc Netw Date: 2014-03-01 Impact factor: 12.693