Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
Int J Dermatol. 2022 Jul;61(7):848-854. doi: 10.1111/ijd.16056. Epub 2022 Jan 31.
The assessment of the sentinel lymph node is a cornerstone of melanoma staging. However, ~80% of sentinel lymph node biopsies (SLNB) are negative and nontherapeutic, and patients are unnecessarily exposed to surgery-related complications. Here, we gauged the potential of the Merlin assay to reduce SLNB-associated complications. The Merlin assay uses clinicopathologic variables and tumor gene expression profiling to identify low-risk patients who may forgo SLNB.
We utilized the Merlin test development cohort to determine SLNB complication rates for procedures performed between 2004 and 2018 at Mayo Clinic. Complications evaluated were lymphedema, seroma, infection/cellulitis, hematoma, and wound dehiscence. Patients who underwent a completion lymph node dissection were excluded.
A total of 558 patients were included. The overall 90-day complication rate specific to SLNB (1 year for lymphedema) was 17.4%. The most common complications were seroma (9.3%), infection/cellulitis (4.8%), and lymphedema (4.3%). All three were more common in patients with a lower extremity primary tumor location versus other locations. With Merlin test results applied, SLNB-related complications would have decreased by 59%.
SLNB is a safe procedure but carries a significant complication rate. Merlin testing might reduce the need for SLNB and its associated complications.
前哨淋巴结评估是黑色素瘤分期的基石。然而，约 80%的前哨淋巴结活检（SLNB）为阴性且无治疗意义，患者因此不必要地暴露于手术相关并发症之下。在此，我们评估 Merlin 检测在降低 SLNB 相关并发症方面的潜力。Merlin 检测使用临床病理变量和肿瘤基因表达谱来识别可能避免 SLNB 的低危患者。
我们利用 Merlin 检测开发队列来确定 2004 年至 2018 年期间在 Mayo 诊所进行的 SLNB 操作的并发症发生率。评估的并发症包括淋巴水肿、血清肿、感染/蜂窝织炎、血肿和伤口裂开。排除了接受淋巴结清扫术的患者。
共纳入 558 例患者。特定于 SLNB（淋巴水肿为 1 年）的 90 天总体并发症率为 17.4%。最常见的并发症是血清肿（9.3%）、感染/蜂窝织炎（4.8%）和淋巴水肿（4.3%）。所有三种并发症在下肢原发性肿瘤部位的患者中更为常见，而非其他部位。如果应用 Merlin 检测结果，SLNB 相关并发症将减少 59%。
SLNB 是一种安全的操作，但存在显著的并发症发生率。Merlin 检测可能减少 SLNB 及其相关并发症的需求。
