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Abstract：
BACKGROUND: Atypical Spitz tumor (AST) is an intermediate category among Spitz melanocytic neoplasms. Sentinel node biopsy (SNB) has been proposed in the clinical management of AST patients, but this approach remains the subject of debate. This systematic review aims to summarize the available evidence on SNB procedures in AST patients.
METHODS: A comprehensive search was conducted, including MEDLINE/Pubmed, EMBASE, and SCOPUS, through April 2023. Case series, cohort studies, and case-control studies of AST patients were eligible for inclusion. PRISMA guidelines were followed.
RESULTS: Twenty-two studies with a total of 756 AST patients were included. The pooled SNB prevalence was 54% (95% CI 32 to 75%), with substantial heterogeneity (I2 90%). The pooled SNB+ prevalence was 35% (95% CI 25 to 46%) with moderate heterogeneity (I2 39%). Lymphadenectomy was performed in 0-100% of SNB+ patients. Overall survival rates ranged from 93% to 100%, and disease-free survival ranged from 87% to 100% in AST patients. Overall and disease-free survival rates were 100% in SNB patients. Pooled survival estimates were not calculated due to the heterogeneous timing of the survival assessment and/or the small size of the subgroups. All studies clearly reported inclusion criteria and measured the condition in a standard way for all participants, but only 50% indicated valid methods for the identification of the condition.
CONCLUSIONS: The oncologic behavior of AST is related to an almost always favorable outcome. SNB does not seem to be relevant as a staging or prognostic procedure, and its indication remains debatable and controversial.
METHODS: A comprehensive search was conducted, including MEDLINE/Pubmed, EMBASE, and SCOPUS, through April 2023. Case series, cohort studies, and case-control studies of AST patients were eligible for inclusion. PRISMA guidelines were followed.
RESULTS: Twenty-two studies with a total of 756 AST patients were included. The pooled SNB prevalence was 54% (95% CI 32 to 75%), with substantial heterogeneity (I2 90%). The pooled SNB+ prevalence was 35% (95% CI 25 to 46%) with moderate heterogeneity (I2 39%). Lymphadenectomy was performed in 0-100% of SNB+ patients. Overall survival rates ranged from 93% to 100%, and disease-free survival ranged from 87% to 100% in AST patients. Overall and disease-free survival rates were 100% in SNB patients. Pooled survival estimates were not calculated due to the heterogeneous timing of the survival assessment and/or the small size of the subgroups. All studies clearly reported inclusion criteria and measured the condition in a standard way for all participants, but only 50% indicated valid methods for the identification of the condition.
CONCLUSIONS: The oncologic behavior of AST is related to an almost always favorable outcome. SNB does not seem to be relevant as a staging or prognostic procedure, and its indication remains debatable and controversial.
摘要：
背景：非典型Spitz肿瘤（AST）是Spitz黑素细胞肿瘤中的一个中间类别。前哨淋巴结活检（SNB）已在AST患者的临床管理中提出，但是这种方法仍然是辩论的主题。本系统综述旨在总结AST患者SNB手术的现有证据。
方法：进行了全面搜索，包括MEDLINE/Pubmed,EMBASE,和Scopus,到2023年4月。案例系列,队列研究，AST患者的病例对照研究符合纳入条件.遵循PRISMA指南。
结果：纳入了22项研究，共756例AST患者。汇总的SNB患病率为54%（95%CI32至75%），具有实质性异质性(I290%)。合并的SNB+患病率为35%（95%CI25-46%），具有中度异质性（I239%）。在0-100％的SNB患者中进行了淋巴结切除术。总生存率从93%到100%,AST患者的无病生存率为87%至100%.SNB患者的总体生存率和无病生存率为100％。由于生存评估的时间不均匀和/或亚组的规模小，未计算合并的生存估计值。所有研究都明确报告了纳入标准，并以标准方式衡量了所有参与者的病情。但只有50%的人指出了识别病情的有效方法。
结论：AST的肿瘤行为与几乎总是有利的结果有关。SNB似乎与分期或预后程序无关，其迹象仍有争议和争议。
方法：进行了全面搜索，包括MEDLINE/Pubmed,EMBASE,和Scopus,到2023年4月。案例系列,队列研究，AST患者的病例对照研究符合纳入条件.遵循PRISMA指南。
结果：纳入了22项研究，共756例AST患者。汇总的SNB患病率为54%（95%CI32至75%），具有实质性异质性(I290%)。合并的SNB+患病率为35%（95%CI25-46%），具有中度异质性（I239%）。在0-100％的SNB患者中进行了淋巴结切除术。总生存率从93%到100%,AST患者的无病生存率为87%至100%.SNB患者的总体生存率和无病生存率为100％。由于生存评估的时间不均匀和/或亚组的规模小，未计算合并的生存估计值。所有研究都明确报告了纳入标准，并以标准方式衡量了所有参与者的病情。但只有50%的人指出了识别病情的有效方法。
结论：AST的肿瘤行为与几乎总是有利的结果有关。SNB似乎与分期或预后程序无关，其迹象仍有争议和争议。
