Sentinel lymph node investigation in melanoma: detailed analysis of the yield from step sectioning and immunohistochemistry

• Published in: Journal of clinical pathology Vol. 57; no. 6; pp. 618 - 620
• Main Authors: Gietema, H A, Vuylsteke, R J C L M, de Jonge, I A, van Leeuwen, P A M, Molenkamp, B G, van der Sijp, J R M, Meijer, S, van Diest, P J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.06.2004; BMJ; BMJ Publishing Group LTD; Copyright 2004 Journal of Clinical Pathology
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy; Breast cancer; Dermatology; H&E; haematoxylin and eosin; Humans; IHC; Immunohistochemistry; Investigative techniques, diagnostic techniques (general aspects); Lymphatic Metastasis; Lymphatic system; Medical sciences; Melanoma; Melanoma - pathology; Melanoma - secondary; Metastasis; Middle Aged; Original; pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; sentinel lymph node; Sentinel Lymph Node Biopsy - methods; sentinel node; Skin Neoplasms - pathology; SLN; Surgery; Tumors of the skin and soft tissue. Premalignant lesions; Workloads; Immunohistochemistry; Anatomic pathology; Biochemical analysis; Malignant tumor; Sentinel lymph node; Malignant melanoma
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.2003.011742

Aims: To evaluate in detail the extent to which step sectioning and immunohistochemical examination of sentinel lymph nodes (SLNs) in patients with melanoma reveal additional node positive patients, to arrive at a sensitive yet workable protocol for histopathological SLN examination. Methods: The study comprised 29 patients with one or more positive SLN after a successful SLN procedure for clinical stage I/II melanoma. SLNs were lamellated into pieces of approximately 0.5 cm in size. One initial haematoxylin and eosin (H&E) stained central cross section was made for each block. When negative, four step ribbons were cut at intervals of 250 μm. One section from each ribbon was stained with H&E, and one was used for immunohistochemistry (IHC). Results: When taking the cumulative total of detected metastases at level 5 as 100%, the percentage of SLN positive patients increased from 79%, 83%, 83%, 90% to 93% in the H&E sections through levels 1–5, and with IHC these values were 83%, 86%, 90%, 97%, and 100%, respectively. One of six patients in whom metastases were detected at levels 2–5 only had metastases in the subsequent additional lymph node dissection. Conclusions: Multiple level sectioning of SLNs (five levels at 250 μm intervals) and the use of IHC detects additional metastases up to the last level in melanoma SLNs. Although more levels of sectioning might increase the yield even further, this protocol ensures a reasonable workload for the pathologist with an acceptable sensitivity when compared with the published literature.