The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease: Multi-center, retrospective study of 151 patients

Highlights • We collected 151 patients with invasive extramammary Paget's disease. • The rate of LN metastasis in patients without lymphadenopathy was 15%. • On the other hand, patients with lymphadenopathy had LN metastasis in 80%. • No difference in survival between patients with or without S...

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Published in	Journal of dermatological science Vol. 79; no. 1; pp. 38 - 42
Main Authors	Fujisawa, Yasuhiro, Yoshino, Koji, Kiyohara, Yoshio, Kadono, Takafumi, Murata, Yozo, Uhara, Hisashi, Hatta, Naohito, Uchi, Hiroshi, Matsushita, Shigeto, Takenouchi, Tatsuya, Hayashi, Toshihiko, Fujimoto, Manabu, Ohara, Kuniaki
Format	Journal Article
Language	English
Published	Netherlands Elsevier Ireland Ltd 01.07.2015
Subjects	Aged Blood Vessels - pathology Dermatology Extramammary Paget's disease Female Humans Lymph Node Excision Lymph Nodes - pathology Lymph Nodes - surgery Lymphadenopathy Lymphatic Diseases - pathology Lymphatic Metastasis Lymphatic Vessels - pathology Male Neoplasm Invasiveness Paget Disease, Extramammary - pathology Paget Disease, Extramammary - secondary Paget Disease, Extramammary - surgery Retrospective Studies Sentinel lymph node Sentinel Lymph Node Biopsy Skin Neoplasms - pathology Skin Neoplasms - surgery Survival Rate Extramammary Paget's disease Lymphadenopathy Sentinel lymph node
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Abstract	Highlights • We collected 151 patients with invasive extramammary Paget's disease. • The rate of LN metastasis in patients without lymphadenopathy was 15%. • On the other hand, patients with lymphadenopathy had LN metastasis in 80%. • No difference in survival between patients with or without SLN metastasis. • Patients with lymphadenopathy showed worse survival than those with positive SLN.
AbstractList	Highlights • We collected 151 patients with invasive extramammary Paget's disease. • The rate of LN metastasis in patients without lymphadenopathy was 15%. • On the other hand, patients with lymphadenopathy had LN metastasis in 80%. • No difference in survival between patients with or without SLN metastasis. • Patients with lymphadenopathy showed worse survival than those with positive SLN. •We collected 151 patients with invasive extramammary Paget's disease.•The rate of LN metastasis in patients without lymphadenopathy was 15%.•On the other hand, patients with lymphadenopathy had LN metastasis in 80%.•No difference in survival between patients with or without SLN metastasis.•Patients with lymphadenopathy showed worse survival than those with positive SLN. Although extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have lymph node metastasis and may develop distant metastasis. Although sentinel lymph node biopsy (SLNB) is widely accepted for various cancers, there is no large study that has assessed its role in iEMPD. The main objective of this study is to assess the role of SLNB in patients with iEMPD. We retrospectively collected data on 151 iEMPD patients treated from 1998 to 2012 in 11 institutes in Japan. All 151 patients received curative surgery for their primary tumor and none of them had distant metastasis. SLNB was performed on the 107 patients without lymphadenopathy to determine their LN status. The 44 other patients with lymphadenopathy underwent one of the following procedures to determine their LN status: SLNB in 22 cases, immediate LN dissection in 21, and LN biopsy in 1. Compared to those without lymphadenopathy, patients with lymphadenopathy had advanced primary tumors (nodule in the primary tumor, thicker tumor, deeper invasion level, and lymphovascular invasion). The rate of LN metastasis in patients with lymphadenopathy was 80%, compared to 15% in patients without lymphadenopathy who underwent SLNB. Compared to those with negative SLN, patients with positive SLN had advanced primary tumors (nodule in the primary tumor, deeper invasion level, and lymphovascular invasion). Multivariate analysis revealed that dermal invasion (odds ratio 5.8, p=0.04) and lymphovascular invasion (odds ratio 18.0, p=0.0023) were independent factors associated with SLN positivity. Notably, there was no difference in survival between patients with or without SLN metastasis (p=0.71). On the other hand, patients with lymphadenopathy showed worse survival than those with positive SLN (p=0.045). Clinical lymphadenopathy was strongly correlated with pathological LN metastasis and also associated with worse survival than absence of lymphadenopathy. The rate of occult LN metastasis detected by SLNB was 15%. Survival was not affected by SLN status even when an advanced primary tumor was present in patients with positive SLN. Our results raise the possibility that SLNB and subsequent LN dissection improved the survival of patients with early stage lymphatic spread. Our study indicates that SLNB should be considered for iEMPD if lymphadenopathy is not apparent. BACKGROUNDAlthough extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have lymph node metastasis and may develop distant metastasis. Although sentinel lymph node biopsy (SLNB) is widely accepted for various cancers, there is no large study that has assessed its role in iEMPD.OBJECTIVEThe main objective of this study is to assess the role of SLNB in patients with iEMPD.MATERIALS AND METHODSWe retrospectively collected data on 151 iEMPD patients treated from 1998 to 2012 in 11 institutes in Japan. All 151 patients received curative surgery for their primary tumor and none of them had distant metastasis. SLNB was performed on the 107 patients without lymphadenopathy to determine their LN status. The 44 other patients with lymphadenopathy underwent one of the following procedures to determine their LN status: SLNB in 22 cases, immediate LN dissection in 21, and LN biopsy in 1.RESULTSCompared to those without lymphadenopathy, patients with lymphadenopathy had advanced primary tumors (nodule in the primary tumor, thicker tumor, deeper invasion level, and lymphovascular invasion). The rate of LN metastasis in patients with lymphadenopathy was 80%, compared to 15% in patients without lymphadenopathy who underwent SLNB. Compared to those with negative SLN, patients with positive SLN had advanced primary tumors (nodule in the primary tumor, deeper invasion level, and lymphovascular invasion). Multivariate analysis revealed that dermal invasion (odds ratio 5.8, p=0.04) and lymphovascular invasion (odds ratio 18.0, p=0.0023) were independent factors associated with SLN positivity. Notably, there was no difference in survival between patients with or without SLN metastasis (p=0.71). On the other hand, patients with lymphadenopathy showed worse survival than those with positive SLN (p=0.045).CONCLUSIONClinical lymphadenopathy was strongly correlated with pathological LN metastasis and also associated with worse survival than absence of lymphadenopathy. The rate of occult LN metastasis detected by SLNB was 15%. Survival was not affected by SLN status even when an advanced primary tumor was present in patients with positive SLN. Our results raise the possibility that SLNB and subsequent LN dissection improved the survival of patients with early stage lymphatic spread. Our study indicates that SLNB should be considered for iEMPD if lymphadenopathy is not apparent. Although extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have lymph node metastasis and may develop distant metastasis. Although sentinel lymph node biopsy (SLNB) is widely accepted for various cancers, there is no large study that has assessed its role in iEMPD. The main objective of this study is to assess the role of SLNB in patients with iEMPD. We retrospectively collected data on 151 iEMPD patients treated from 1998 to 2012 in 11 institutes in Japan. All 151 patients received curative surgery for their primary tumor and none of them had distant metastasis. SLNB was performed on the 107 patients without lymphadenopathy to determine their LN status. The 44 other patients with lymphadenopathy underwent one of the following procedures to determine their LN status: SLNB in 22 cases, immediate LN dissection in 21, and LN biopsy in 1. Compared to those without lymphadenopathy, patients with lymphadenopathy had advanced primary tumors (nodule in the primary tumor, thicker tumor, deeper invasion level, and lymphovascular invasion). The rate of LN metastasis in patients with lymphadenopathy was 80%, compared to 15% in patients without lymphadenopathy who underwent SLNB. Compared to those with negative SLN, patients with positive SLN had advanced primary tumors (nodule in the primary tumor, deeper invasion level, and lymphovascular invasion). Multivariate analysis revealed that dermal invasion (odds ratio 5.8, p=0.04) and lymphovascular invasion (odds ratio 18.0, p=0.0023) were independent factors associated with SLN positivity. Notably, there was no difference in survival between patients with or without SLN metastasis (p=0.71). On the other hand, patients with lymphadenopathy showed worse survival than those with positive SLN (p=0.045). Clinical lymphadenopathy was strongly correlated with pathological LN metastasis and also associated with worse survival than absence of lymphadenopathy. The rate of occult LN metastasis detected by SLNB was 15%. Survival was not affected by SLN status even when an advanced primary tumor was present in patients with positive SLN. Our results raise the possibility that SLNB and subsequent LN dissection improved the survival of patients with early stage lymphatic spread. Our study indicates that SLNB should be considered for iEMPD if lymphadenopathy is not apparent.
Author	Kiyohara, Yoshio Matsushita, Shigeto Uhara, Hisashi Ohara, Kuniaki Hatta, Naohito Fujimoto, Manabu Hayashi, Toshihiko Takenouchi, Tatsuya Fujisawa, Yasuhiro Yoshino, Koji Kadono, Takafumi Murata, Yozo Uchi, Hiroshi
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Keywords	Extramammary Paget's disease Lymphadenopathy Sentinel lymph node
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Snippet	Highlights • We collected 151 patients with invasive extramammary Paget's disease. • The rate of LN metastasis in patients without lymphadenopathy was 15%. •... •We collected 151 patients with invasive extramammary Paget's disease.•The rate of LN metastasis in patients without lymphadenopathy was 15%.•On the other... Although extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have... BACKGROUNDAlthough extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD)...
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SubjectTerms	Aged Blood Vessels - pathology Dermatology Extramammary Paget's disease Female Humans Lymph Node Excision Lymph Nodes - pathology Lymph Nodes - surgery Lymphadenopathy Lymphatic Diseases - pathology Lymphatic Metastasis Lymphatic Vessels - pathology Male Neoplasm Invasiveness Paget Disease, Extramammary - pathology Paget Disease, Extramammary - secondary Paget Disease, Extramammary - surgery Retrospective Studies Sentinel lymph node Sentinel Lymph Node Biopsy Skin Neoplasms - pathology Skin Neoplasms - surgery Survival Rate
Title	The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease: Multi-center, retrospective study of 151 patients
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