John Dekker1, Lyn M Duncan. 1. From the Department of Pathology, Massachusetts General Hospital, Boston.
Abstract
CONTEXT: Detection of microscopic melanoma metastases in sentinel lymph nodes drives clinical care; patients without metastases are observed, and patients with metastases are offered completion lymphadenectomy and adjuvant therapy. OBJECTIVE: We sought to determine common elements in currently used analytic platforms for sentinel lymph nodes in melanoma patients. DESIGN: An electronic survey was distributed to 83 cancer centers in North America. RESULTS: Seventeen responses (20%) were received. The number of sentinel lymph node mapping procedures for melanoma ranged from less than 11 to more than 100 patients per year, with 72% of institutions mapping more than 50 melanoma patients a year. Uniform practices included (1) processing all of the lymph node tissue rather than submitting representative sections and (2) use of immunohistochemical stains if no tumor was identified on the hematoxylin-eosin-stained sections. Significant variability existed regarding the method of sectioning lymph nodes at grossing and in the histology laboratory; most bisected nodes longitudinally (94%) and performed deeper levels into the block (67%), but these were not uniform practices. S-100 was the most commonly used immunohistochemical stain (78%), followed by Melan-A (56%), MART-1 (50%), HMB-45 (44%), tyrosinase (33%), MiTF (11%), and pan-melanoma (6%). CONCLUSIONS: There is a need for a standardized platform for detecting melanoma in sentinel lymph nodes. Current practices by a majority of laboratories and findings in the reported literature support the following: histologic evaluation of all lymph node tissue, use of immunohistochemical stains, bisecting lymph nodes longitudinally, and performing deeper levels into the tissue block.
CONTEXT: Detection of microscopic melanoma metastases in sentinel lymph nodes drives clinical care; patients without metastases are observed, and patients with metastases are offered completion lymphadenectomy and adjuvant therapy. OBJECTIVE: We sought to determine common elements in currently used analytic platforms for sentinel lymph nodes in melanomapatients. DESIGN: An electronic survey was distributed to 83 cancer centers in North America. RESULTS: Seventeen responses (20%) were received. The number of sentinel lymph node mapping procedures for melanoma ranged from less than 11 to more than 100 patients per year, with 72% of institutions mapping more than 50 melanomapatients a year. Uniform practices included (1) processing all of the lymph node tissue rather than submitting representative sections and (2) use of immunohistochemical stains if no tumor was identified on the hematoxylin-eosin-stained sections. Significant variability existed regarding the method of sectioning lymph nodes at grossing and in the histology laboratory; most bisected nodes longitudinally (94%) and performed deeper levels into the block (67%), but these were not uniform practices. S-100 was the most commonly used immunohistochemical stain (78%), followed by Melan-A (56%), MART-1 (50%), HMB-45 (44%), tyrosinase (33%), MiTF (11%), and pan-melanoma (6%). CONCLUSIONS: There is a need for a standardized platform for detecting melanoma in sentinel lymph nodes. Current practices by a majority of laboratories and findings in the reported literature support the following: histologic evaluation of all lymph node tissue, use of immunohistochemical stains, bisecting lymph nodes longitudinally, and performing deeper levels into the tissue block.
Authors: Catherine Alix-Panabieres; Anthony Magliocco; Luis Enrique Cortes-Hernandez; Zahra Eslami-S; Daniel Franklin; Jane L Messina Journal: Clin Exp Metastasis Date: 2021-05-07 Impact factor: 5.150