Highlights
- •Melanoma cell densities in the sentinel node accurately reflect melanoma outcome.
- •Quantitative immunocytology outperforms semiquantitative pathology.
- •Pathological examination may be restricted to qualitative examination of few slides.
Abstract
Introduction
Sentinel node biopsy is a key procedure to predict prognosis in melanoma. In a prospective
study we compare reporting on melanoma cell densities in cytospin preparations with
semiquantitative histopathology for predicting outcome.
Patients and methods
Sentinel nodes from 900 melanoma patients were bisected. One half of each node was
disaggregated mechanically. The melanoma cell density (number of HMB45 positive cells
per million lymphocytes with at least one cell showing morphological features of a
melanoma cell) was recorded after examining two cytospins. For the second half the
maximum diameter of metastasis was determined after haematoxylin and eosin (H&E) and
immunohistological staining of three slides.
Results
Cytospins were positive for melanoma in 218 of 900 patients (24%). Routine pathology
was positive in 111 of 900 (12%) patients. A more extensive pathological workup in
cytospin-only positive patients led to a revised diagnosis (from negative to positive)
in 23 of 101 patients (22.7%). We found a moderate but significant correlation between
melanoma cell densities (determined in cytospins) and the maximum diameter of metastasis
(determined by pathology) (rho = 0.6284, p < 0.001). At a median follow-up of 37 months
(IQR 25–53 months) melanoma cell density (cytospins) (p < 0.001), thickness of melanoma
(p = 0.008) and ulceration status (p = 0.026) were significant predictors for melanoma
specific survival by multivariable testing and were all confirmed as key predictive
factors by the random forest model. Maximum diameter of metastases, age and sex were
not significant by multivariable testing (all p > 0.05).
Conclusion
Recording melanoma cell densities by examining two cytospins accurately predicts melanoma
outcome and outperforms semiquantitative histopathology.
Keywords
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Article info
Publication history
Published online: August 19, 2022
Accepted:
June 27,
2022
Received in revised form:
June 17,
2022
Received:
February 25,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
