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. 2011 Mar 10;29(8):1036-41.
doi: 10.1200/JCO.2010.33.4136. Epub 2011 Feb 7.

Features predicting sentinel lymph node positivity in Merkel cell carcinoma

Jennifer L Schwartz  1 , Kent A Griffith, Lori Lowe, Sandra L Wong, Scott A McLean, Douglas R Fullen, Christopher D Lao, James A Hayman, Carol R Bradford, Riley S Rees, Timothy M Johnson, Christopher K Bichakjian
Affiliations

Features predicting sentinel lymph node positivity in Merkel cell carcinoma

Jennifer L Schwartz et al. J Clin Oncol. .

Abstract

Purpose: Merkel cell carcinoma (MCC) is a relatively rare, potentially aggressive cutaneous malignancy. We examined the clinical and histologic features of primary MCC that may correlate with the probability of a positive sentinel lymph node (SLN).

Methods: Ninety-five patients with MCC who underwent SLN biopsy at the University of Michigan were identified. SLN biopsy was performed on 97 primary tumors, and an SLN was identified in 93 instances. These were reviewed for clinical and histologic features and associated SLN positivity. Univariate associations between these characteristics and a positive SLN were tested for by using either the χ(2) or the Fisher's exact test. A backward elimination algorithm was used to help create a best multiple variable model to explain a positive SLN.

Results: SLN positivity was significantly associated with the clinical size of the lesion, greatest horizontal histologic dimension, tumor thickness, mitotic rate, and histologic growth pattern. Two competing multivariate models were generated to predict a positive SLN. The histologic growth pattern was present in both models and combined with either tumor thickness or mitotic rate.

Conclusion: Increasing clinical size, increasing tumor thickness, increasing mitotic rate, and infiltrative tumor growth pattern were significantly associated with a greater likelihood of a positive SLN. By using the growth pattern and tumor thickness model, no subgroup of patients was predicted to have a lower than 15% to 20% likelihood of a positive SLN. This suggests that all patients presenting with MCC without clinical evidence of regional lymph node disease should be considered for SLN biopsy.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Predicted probability of at least one positive sentinel lymph node (PSLN) by tumor thickness and growth pattern.
Fig 2.
Fig 2.
Cytokeratin-20 immunostain identifies Merkel cell carcinoma micrometastases composed of only rare single cells in a sentinel lymph node (×200).
See this image and copyright information in PMC

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