Vanderbilt University Medical Center, Division of General Surgery, Nashville, Tennessee.
Vanderbilt University Medical Center, Division of Surgical Oncology and Endocrine Surgery, Nashville, Tennessee.
J Surg Res. 2020 Jun;250:97-101. doi: 10.1016/j.jss.2019.12.044. Epub 2020 Feb 7.
Prior studies of internal pathology review (IPR) for melanoma have shown that changes in the pathology analysis are common. How these changes impact clinical management of melanoma or how the margin status reports may modify has not been evaluated. Our goal was to determine what changes to staging and surgical management occurred after IPR of newly diagnosed melanomas and to determine how the final surgical pathology report may correlate with the IPR.
A retrospective study was conducted from 2014 to 2016 of newly diagnosed invasive melanomas referred to a single National Comprehensive Cancer Network tertiary care center.
A total of 370 cases met inclusion criteria. The most common feature changed after internal review was mitotic rate, in 155 (41.7%) patients, followed by Breslow depth in 99 (26.9%) patients. Tumor staging was changed in 45 (12.2%) patients. The most common change was a T1a lesion being upgraded to a T1b lesion. These tumor staging changes lead to 38 (10.3%) overall staging differences. A biopsy's deep margin status was changed in 27 (7.3%) patients. Outside hospital reports lacked information about deep margin status in 71 (19.2%) of specimens. Based on the National Comprehensive Cancer Network guidelines, 22 (5.9%) patients had changes in their sentinel lymph node biopsy recommendations and one of these patients had a positive node found on pathology. Of those patients who had changes in the T-stage, 16 (4.3%) of them also had changes in the recommended wide local excision radial margin.
IPR of invasive melanoma leads to both changes in staging and the surgical management of melanoma and should remain an important component of care of melanoma patients at a tertiary referral center.
先前对黑色素瘤的内部病理学复查（IPR）的研究表明，病理学分析的变化很常见。这些变化如何影响黑色素瘤的临床管理，或者边缘状态报告如何修改，尚未得到评估。我们的目标是确定在对新诊断的黑色素瘤进行 IPR 后分期和手术管理发生了哪些变化，并确定最终的手术病理报告与 IPR 的相关性。
对 2014 年至 2016 年间在一家国家综合癌症网络三级治疗中心就诊的新诊断的侵袭性黑色素瘤进行了回顾性研究。
共有 370 例符合纳入标准。内部审查后最常见的变化特征是有丝分裂率，有 155 例（41.7%）患者，其次是 Breslow 深度有 99 例（26.9%）患者。肿瘤分期改变的有 45 例（12.2%）患者。最常见的变化是 T1a 病变升级为 T1b 病变。这些肿瘤分期变化导致 38 例（10.3%）总体分期差异。27 例（7.3%）患者的活检深层边缘状态发生改变。71 例（19.2%）标本的外部医院报告缺乏关于深层边缘状态的信息。根据国家综合癌症网络指南，22 例（5.9%）患者的前哨淋巴结活检建议发生改变，其中 1 例患者的病理检查发现淋巴结阳性。在 T 分期发生变化的患者中，16 例（4.3%）患者的推荐广泛局部切除放射状边缘也发生了变化。
侵袭性黑色素瘤的 IPR 会导致分期和黑色素瘤手术管理的变化，应仍然是三级转诊中心黑色素瘤患者护理的重要组成部分。
