Predictors and survival impact of false-negative sentinel nodes in melanoma

Abstract

Background: The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable. Methods: We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database. Results: Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93\ua0months), the incidence of FN-SNB was 2.8\ua0%. While calculated FN rate was 14.5\ua0% [84 FN/(494 TP\ua0+\ua084 FN)\ua0×\ua0100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5\ua0% [46 FN/(494 TP\ua0+\ua046 FN)\ua0×\ua0100\ua0%]. On multivariate analysis, male gender (OR 2.0, 95\ua0% CI 1.1–3.6, p\ua0=\ua00.018), head/neck primaries (OR 2.5, 95\ua0% CI 1.3–4.8, p\ua