Limitations of SLNB as a Prognostic Indicator in Melanoma
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National guidelines recommend that the SLNB procedure be considered for patients with T1b tumors and above, as well as T1a tumors with high-risk features, based on an expected risk of SLN positivity exceeding 5%. This 5% risk threshold is based on the SLNB false negative rate observed in the Multicenter Selective Lymphadenectomy Trial (MSLT-I; Morton 2014), which showed that the SLNB procedure had no impact on survival. Use of this threshold results in an overall rate of SLNB positivity of approximately 12% (Ellis 2010; Bamboat 2014; Joyce 2017).
Thus, while providing prognostic information the SLNB procedure has significant limitations:
No survival benefit for SLNB surgical procedure and low sensitivity (two-thirds of melanoma deaths in SLN negative group) (Morton 2014)
Negative SLN result in approximately 88% of patients undergoing an SLNB surgical procedure
False negative rate of SLNB procedure reported to be 5-21%
Exposure to anesthesia risks and surgical complication rate of 11% (Moody 2016)
There is a clear need to identify patients with sufficiently low risk of a positive node who can safely avoid the SLNB procedure, as well as identify patients who may have a high risk of a positive node and should consider the SLNB procedure.