Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Ann Surg Oncol. 2019 May;26(5):1494-1502. doi: 10.1245/s10434-019-07204-2. Epub 2019 Feb 4.
Over recent years, sentinel lymph node biopsy (SLNB) recommendations in guidelines for cutaneous melanoma have changed considerably. We aimed to assess trends in enactment of SLNB to evaluate to what extent guidelines were adhered to, and to identify clinical and pathological determinants of (non-)adherence.
Clinicopathological data from the Dutch nationwide network and registry of histopathology and cytopathology were retrieved from patients diagnosed with primary cutaneous melanoma in The Netherlands between 2003 and 2014. SLNB enactment was analyzed per year. Multivariable regression models were developed to assess the determinants of SLNB enactment.
A total of 51,510 primary cutaneous melanomas in 49,514 patients were diagnosed, of which 24,603 melanomas were eligible for SLNB as they were staged T1b or higher. In practice, only 9761 (39.7%) patients underwent SLNB, with an increasing trend from 39.1% in 2003 to 47.8% in 2014 (p < 0.001). A total of 759 (2.9%) of 26,426 patients without SLNB indication underwent SLNB anyway. Variables significantly associated with enactment of SLNB were male sex, younger age, and melanoma on sites other than the head and neck.
Although there was an increasing trend in time in SLNB enactment, enactment of SLNB did not comply well with recommendations in (inter)national guidelines. Female sex, higher age, and melanoma located on the head and neck were associated with non-enactment of SLNB.
近年来，皮肤黑色素瘤指南中对前哨淋巴结活检（SLNB）的推荐发生了很大变化。我们旨在评估 SLNB 的实施趋势，以评估指南的遵循程度，并确定（不）遵循的临床和病理决定因素。
从荷兰全国性的组织病理学和细胞学网络和登记处检索了 2003 年至 2014 年间在荷兰诊断为原发性皮肤黑色素瘤的患者的临床病理数据。每年分析 SLNB 的实施情况。建立多变量回归模型来评估 SLNB 实施的决定因素。
共诊断出 51510 例原发性皮肤黑色素瘤，涉及 49514 名患者，其中 24603 例黑色素瘤分期为 T1b 或更高，有资格进行 SLNB。实际上，只有 9761 例（39.7%）患者接受了 SLNB，从 2003 年的 39.1%到 2014 年的 47.8%呈上升趋势（p<0.001）。共有 759 例（2.9%）无 SLNB 指征的患者仍接受了 SLNB。与 SLNB 实施显著相关的变量包括男性、年轻和位于头颈部以外的黑色素瘤。
尽管 SLNB 的实施呈上升趋势，但实施情况并未完全符合（国际）指南的建议。女性、较高的年龄和位于头颈部的黑色素瘤与不实施 SLNB 相关。
