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Complications Associated With Sentinel Lymph Node Biopsy for Melanoma

Overview. Sentinel lymph node (SLN) biopsy has become widely accepted as a method of staging the regional lymph nodes for patients with melanoma. SLN biopsy is a minimally invasive procedure associated with few complications Little evidence is available in the literature to support this claim . Ba

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Complications Associated With Sentinel Lymph Node Biopsy for Melanoma

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    1. Complications Associated With Sentinel Lymph Node Biopsy for Melanoma Journal Club Presentation Tushar Halder 1/09/03

    2. Overview Sentinel lymph node (SLN) biopsy has become widely accepted as a method of staging the regional lymph nodes for patients with melanoma. SLN biopsy is a minimally invasive procedure associated with few complications Little evidence is available in the literature to support this claim

    3. Background Purpose to determine the morbidity associated with SLN biopsy To compare the morbidity of SLN biopsy with that of completion lymph node dissection (CLND) Hypothesis- complications associated with SLN biopsy are less than those associated with CLND or elective lymph node dissection (ELND)

    4. Methods A randomised prospective trial involving 70 institutions across the United States, between June 1997 and June 2001 Complications associated with SLN biopsy alone were compared with those associated with SLN biopsy plus CLND. Inclusion criteria- Patients 18 to 70 years old with cutaneous melanomas >=1.0 mm Breslow thickness and clinically negative regional lymph nodes

    5. Methods Both radioactive colloid and isosulfan blue dye injection used to identify SLN Histological analysis was done with hematoxylin and eosin staining at multiple levels, followed by immunohistochemical staining for S-100 protein Frozen-section analysis of SLNs was not performed

    6. Result A total of 2120 patients were evaluated, with A median follow-up of 16 months 96 (4.6%) of 2120 patients developed major or minor complications associated with SLN biopsy 103 (23.2%) of 444 patients experienced complications associated with SLN biopsy plus CLND There were no deaths associated with either procedure

    10. Conclusion SLN biopsy alone is associated with significantly less morbidity compared with SLN biopsy plus CLND Most complications of SLN biopsy were minor and easily managed. Lymphedema can result from SLN biopsy alone in rare cases

    11. Strengths of Study A randomised prospective multi-institutional study Sample size was adequate A total of 2120 patients were enrolled in the study 1676 patients underwent SLN biopsy alone, and 444 underwent SLN biopsy followed by CLND The frequency of complications was also evaluated by nodal basin distribution

    12. Weakness of the Study The comparison in this study was not between SLN biopsy and ELND Lymphedema was not evaluated in this study by prospective evaluation of limb volume or circumference, but was defined as clinically apparent swelling of the extremity The median follow-up for the study was 16 months

    13. Applicability to Clinical Practice This study provided evidence to support the SLN biopsy as a less invasive procedure associated with minimum complications It presented ideas for future research between SLN biopsy and ELND

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