Abstract：
OBJECTIVE: Even though extensive melanoma sentinel node (SN) pathology protocols increase metastasis detection, there is a need for balancing high detection rates with reasonable workload. A newly tested Danish protocol recommended examining nodes at six levels 150 µm apart (six-level model) and using SOX10 and Melan-A immunohistochemistry (IHC). We explored if a protocol examining 3 levels 300 µm apart (three-level model) combined with IHC would compromise metastasis detection. The study aim was to optimise the protocol to reduce workload without compromising detection rate.
METHODS: 8 months after protocol implementation, we reviewed the pathology reports of SNs from 507 melanoma patients nationwide, including 117 SN-positive patients. Each report was reviewed to determine histopathological features, including detection of metastasis, exact levels with metastasis, exact levels with metastasis >1 mm in diameter and IHC results.
RESULTS: The six-level model detected metastases in 23% of patients, whereas the three-level model would have detected metastases in 22% of patients. The three-level model would have missed a few small metastases (n=4), measuring <0.1 mm, 0.1 mm, 0.4 mm and 0.1 mm, respectively. The six-level model detected metastases >1 mm in 7% of patients. One of these metastases (measuring 1.1 mm) would have been detected by the three-level model, but not as >1 mm. SOX10 and Melan-A had equal sensitivity.
CONCLUSIONS: Reducing the number of levels examined to three levels 300 µm apart combined with IHC does not have significant impact on metastasis detection rate, and we will therefore recommend that the future melanoma SN guideline takes this into consideration to reduce overall workload.
METHODS: 8 months after protocol implementation, we reviewed the pathology reports of SNs from 507 melanoma patients nationwide, including 117 SN-positive patients. Each report was reviewed to determine histopathological features, including detection of metastasis, exact levels with metastasis, exact levels with metastasis >1 mm in diameter and IHC results.
RESULTS: The six-level model detected metastases in 23% of patients, whereas the three-level model would have detected metastases in 22% of patients. The three-level model would have missed a few small metastases (n=4), measuring <0.1 mm, 0.1 mm, 0.4 mm and 0.1 mm, respectively. The six-level model detected metastases >1 mm in 7% of patients. One of these metastases (measuring 1.1 mm) would have been detected by the three-level model, but not as >1 mm. SOX10 and Melan-A had equal sensitivity.
CONCLUSIONS: Reducing the number of levels examined to three levels 300 µm apart combined with IHC does not have significant impact on metastasis detection rate, and we will therefore recommend that the future melanoma SN guideline takes this into consideration to reduce overall workload.
摘要：
目的：尽管广泛的黑色素瘤前哨淋巴结（SN）病理学方案增加了转移检测，需要平衡高检测率与合理的工作量。一个新测试的丹麦方案建议在相距150µm（六级模型）的六个级别检查节点，并使用SOX10和Melan-A免疫组织化学（IHC）。我们探索了检查3级300µm分开的协议（三级模型）与IHC结合是否会损害转移检测。该研究的目的是优化协议，以减少工作量而不影响检测率。
方法：协议实施后8个月，我们回顾了全国507名黑色素瘤患者的SNs病理报告，包括117名SN阳性患者。对每份报告进行审查以确定组织病理学特征，包括检测转移，与转移的确切水平，转移直径>1mm的确切水平和IHC结果。
结果：六级模型在23％的患者中检测到转移，而三级模型会在22%的患者中检测到转移.三级模型会错过一些小的转移（n=4），测量<0.1mm,0.1mm,0.4毫米和0.1毫米，分别。六级模型在7%的患者中检测到转移>1mm。这些转移中的一个（测量1.1毫米）可以通过三级模型检测到，但不是>1毫米。SOX10和Melan-A具有相等的灵敏度。
结论：将检查的水平数量减少到三个水平，相距300µm，结合IHC对转移检出率没有显着影响，因此,我们将建议未来的黑色素瘤SN指南考虑到这一点,以减少整体工作量.
方法：协议实施后8个月，我们回顾了全国507名黑色素瘤患者的SNs病理报告，包括117名SN阳性患者。对每份报告进行审查以确定组织病理学特征，包括检测转移，与转移的确切水平，转移直径>1mm的确切水平和IHC结果。
结果：六级模型在23％的患者中检测到转移，而三级模型会在22%的患者中检测到转移.三级模型会错过一些小的转移（n=4），测量<0.1mm,0.1mm,0.4毫米和0.1毫米，分别。六级模型在7%的患者中检测到转移>1mm。这些转移中的一个（测量1.1毫米）可以通过三级模型检测到，但不是>1毫米。SOX10和Melan-A具有相等的灵敏度。
结论：将检查的水平数量减少到三个水平，相距300µm，结合IHC对转移检出率没有显着影响，因此,我们将建议未来的黑色素瘤SN指南考虑到这一点,以减少整体工作量.
