Clinical Relevance of Molecular Staging for Melanoma
Identifieur interne : 00A800 ( Main/Merge ); précédent : 00A799; suivant : 00A801Clinical Relevance of Molecular Staging for Melanoma
Auteurs : Weiguo Li ; Alec Stall ; Steven C. Shivers ; Jeffrey Lin ; Fadi Haddad ; Jane Messina ; L. Frank Glass ; Gary Lyman ; Douglas S. ReintgenSource :
- Annals of Surgery [ 0003-4932 ] ; 2000.
Abstract
To determine the clinical significance of a molecular assay based on the reverse transcriptase polymerase chain reaction (RT-PCR) for the presence of micrometastatic melanoma cells in sentinel lymph nodes (SLNs).
Routine histologic examination of lymph nodes often underestimates the presence of micrometastatic disease. The authors have previously shown that an RT-PCR assay designed to detect melanocyte-specific expression of the tyrosinase gene could be used to define a population of patients at higher risk for both recurrence and death compared with routine hematoxylin and eosin (H&E) histology. In this study, the authors used the tyrosinase RT-PCR assay in a patient population examined by a more detailed histologic analysis, including S-100 immunohistochemistry.
Patients underwent lymphatic mapping and SLN biopsy. SLN specimens were bivalved, and half of each specimen was serially sectioned and examined by routine H&E histology and S-100 immunohistochemistry. The other half of each specimen was analyzed by a nested RT-PCR assay.
Hematoxylin and eosin histology detected metastatic disease in 36 (16%) of the 233 patients tested. S-100 immunohistochemistry detected micrometastatic disease in another 16 patients, and 114 (63%) of 181 patients with histology-negative nodes had positive findings on RT-PCR. There were significant differences between PCR-positive and PCR-negative patient groups in Breslow thickness, Clark level, and the presence of ulceration of the primary tumor, factors that have been shown to correlate with recurrence and survival.
These results suggest that RT-PCR can increase the sensitivity of detection of metastatic melanoma cells in SLNs over the current standard methods, including H&E histology and S-100 immunohistochemistry. Further long-term follow-up is needed to detect actual differences in recurrence and overall survival.
Url:
PubMed: 10816622
PubMed Central: 1421068
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<author><name sortKey="Li, Weiguo" sort="Li, Weiguo" uniqKey="Li W" first="Weiguo" last="Li">Weiguo Li</name>
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<author><name sortKey="Stall, Alec" sort="Stall, Alec" uniqKey="Stall A" first="Alec" last="Stall">Alec Stall</name>
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<author><name sortKey="Shivers, Steven C" sort="Shivers, Steven C" uniqKey="Shivers S" first="Steven C." last="Shivers">Steven C. Shivers</name>
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<author><name sortKey="Lin, Jeffrey" sort="Lin, Jeffrey" uniqKey="Lin J" first="Jeffrey" last="Lin">Jeffrey Lin</name>
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<author><name sortKey="Haddad, Fadi" sort="Haddad, Fadi" uniqKey="Haddad F" first="Fadi" last="Haddad">Fadi Haddad</name>
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<author><name sortKey="Messina, Jane" sort="Messina, Jane" uniqKey="Messina J" first="Jane" last="Messina">Jane Messina</name>
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<author><name sortKey="Glass, L Frank" sort="Glass, L Frank" uniqKey="Glass L" first="L. Frank" last="Glass">L. Frank Glass</name>
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<author><name sortKey="Lyman, Gary" sort="Lyman, Gary" uniqKey="Lyman G" first="Gary" last="Lyman">Gary Lyman</name>
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<author><name sortKey="Reintgen, Douglas S" sort="Reintgen, Douglas S" uniqKey="Reintgen D" first="Douglas S." last="Reintgen">Douglas S. Reintgen</name>
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<author><name sortKey="Stall, Alec" sort="Stall, Alec" uniqKey="Stall A" first="Alec" last="Stall">Alec Stall</name>
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<author><name sortKey="Shivers, Steven C" sort="Shivers, Steven C" uniqKey="Shivers S" first="Steven C." last="Shivers">Steven C. Shivers</name>
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<author><name sortKey="Lin, Jeffrey" sort="Lin, Jeffrey" uniqKey="Lin J" first="Jeffrey" last="Lin">Jeffrey Lin</name>
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<author><name sortKey="Haddad, Fadi" sort="Haddad, Fadi" uniqKey="Haddad F" first="Fadi" last="Haddad">Fadi Haddad</name>
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<author><name sortKey="Messina, Jane" sort="Messina, Jane" uniqKey="Messina J" first="Jane" last="Messina">Jane Messina</name>
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<author><name sortKey="Glass, L Frank" sort="Glass, L Frank" uniqKey="Glass L" first="L. Frank" last="Glass">L. Frank Glass</name>
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<author><name sortKey="Lyman, Gary" sort="Lyman, Gary" uniqKey="Lyman G" first="Gary" last="Lyman">Gary Lyman</name>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective</title>
<p>To determine the clinical significance of a molecular assay based on the reverse transcriptase polymerase chain reaction (RT-PCR) for the presence of micrometastatic melanoma cells in sentinel lymph nodes (SLNs).</p>
</sec>
<sec><title>Summary Background Data</title>
<p>Routine histologic examination of lymph nodes often underestimates the presence of micrometastatic disease. The authors have previously shown that an RT-PCR assay designed to detect melanocyte-specific expression of the tyrosinase gene could be used to define a population of patients at higher risk for both recurrence and death compared with routine hematoxylin and eosin (H&E) histology. In this study, the authors used the tyrosinase RT-PCR assay in a patient population examined by a more detailed histologic analysis, including S-100 immunohistochemistry.</p>
</sec>
<sec><title>Methods</title>
<p>Patients underwent lymphatic mapping and SLN biopsy. SLN specimens were bivalved, and half of each specimen was serially sectioned and examined by routine H&E histology and S-100 immunohistochemistry. The other half of each specimen was analyzed by a nested RT-PCR assay.</p>
</sec>
<sec><title>Results</title>
<p>Hematoxylin and eosin histology detected metastatic disease in 36 (16%) of the 233 patients tested. S-100 immunohistochemistry detected micrometastatic disease in another 16 patients, and 114 (63%) of 181 patients with histology-negative nodes had positive findings on RT-PCR. There were significant differences between PCR-positive and PCR-negative patient groups in Breslow thickness, Clark level, and the presence of ulceration of the primary tumor, factors that have been shown to correlate with recurrence and survival.</p>
</sec>
<sec><title>Conclusions</title>
<p>These results suggest that RT-PCR can increase the sensitivity of detection of metastatic melanoma cells in SLNs over the current standard methods, including H&E histology and S-100 immunohistochemistry. Further long-term follow-up is needed to detect actual differences in recurrence and overall survival.</p>
</sec>
</div>
</front>
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