Van Doren Amelia Stapleton, Shah Hemali, Ata Ashar, Davis Lindy
Albany Medical College, Albany, NY, USA.
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Ann Surg Oncol. 2025 Feb 7. doi: 10.1245/s10434-025-16971-0.
Regional lymph nodes are a common first site of metastasis in patients diagnosed with invasive melanoma. Knowledge of sentinel lymph node status provides strong prognostic information in melanoma and is important for staging and treatment decisions. The National Comprehensive Cancer Network (NCCN) recommends performance of sentinel lymph node biopsy (SLNB) for melanoma patients with a T category of ≥T2a. This study aims to assess our academic institution's guideline adherence to improve quality of care.
Retrospective review of medical records from 2017 to 2023 identified 628 patients referred to our institution for invasive melanoma treatment. Adherence to guidelines was assessed using Chi-square analyses and Fisher's exact tests.
In total, 8.2% of cases did not follow the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for SLNB. When justification provided within the medical record was considered adherent to guidelines, our rate of discordance was 1.6%. Head and neck melanomas were more likely to have guideline-discordant SLNB management, regardless of whether or not a justification was provided.
Greater than 98% of melanoma cases at our institution aligned with the SLNB NCCN Guidelines. We outlined the complex justifications physicians and patients may use to pursue care that is nonadherent to guidelines. Employment of SLNB may be limited by medical comorbidities, surgical risks, and when the management would not change based on the result. Our study provides a blueprint for institutional assessment of guideline adherence and highlights the importance of documentation and guideline dissemination.
区域淋巴结是侵袭性黑色素瘤患者常见的首个转移部位。前哨淋巴结状态的信息为黑色素瘤提供了强有力的预后信息，对分期和治疗决策很重要。美国国立综合癌症网络（NCCN）建议对T分类≥T2a的黑色素瘤患者进行前哨淋巴结活检（SLNB）。本研究旨在评估我们学术机构对指南的遵循情况，以提高医疗质量。
回顾性分析2017年至2023年的病历，确定628例转诊至我院接受侵袭性黑色素瘤治疗的患者。使用卡方分析和费舍尔精确检验评估对指南的遵循情况。
总体而言，8.2%的病例未遵循NCCN肿瘤临床实践指南（NCCN指南）进行SLNB。当将病历中提供的理由视为符合指南时，我们的不一致率为1.6%。无论是否提供理由，头颈部黑色素瘤更有可能出现不符合指南的SLNB管理。
我院超过98%的黑色素瘤病例符合SLNB的NCCN指南。我们概述了医生和患者可能用于寻求不符合指南治疗的复杂理由。SLNB的应用可能受到医疗合并症、手术风险以及基于结果管理不会改变的情况的限制。我们的研究为机构评估指南遵循情况提供了蓝图，并强调了记录和指南传播的重要性。
