Originally published as JCO Early Release 10.1200/JCO.2007.13.7653 on November 3 2008

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Impact of Molecular Staging Methods in Primary Melanoma: Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) of Ultrasound-Guided Aspirate of the Sentinel Node Does Not Improve Diagnostic Accuracy, But RT-PCR of Peripheral Blood Does Predict Survival

Christiane A. Voit, Gregor Schäfer-Hesterberg, Martina Kron, Alexander C.J. van Akkooi, Juergen Rademaker, Ansgar Lukowsky, Alfred Schoengen, Markus Schwürzer-Voit, Wolfram Sterry, Markus Krause, Joachim Röwert-Huber, Alexander M.M. Eggermont

From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Christiane Voit, MD, Klinik für Dermatologie, Venerologie und Allergologie, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; e-mail: christiane.voit{at}t-online.de

Purpose This study analyzes (1) the value of tyrosinase reverse-transcriptase polymerase chain reaction (RT-PCR) of aspirates obtained by ultrasound-guided fine-needle aspiration cytology (US-FNAC) of sentinel nodes (SNs) in patients with melanoma before sentinel lymph node biopsy (SLNB) and (2) the value of RT-PCR of blood samples of all SLNB patients.

Patients and Methods Between 2001 and 2003, 127 patients with melanoma (median Breslow depth, 2.1 mm) underwent SLNB. FNAC was performed in all SNs of all patients pre- and post-SLNB. The aspirates were partly shock-frozen for RT-PCR and were partly used for standard cytology. Peripheral blood was collected at the time of SLNB and at every outpatient visit thereafter.

Results Thirty-four (23%) of 120 SNs were positive for melanoma. SN involvement was predicted by US-FNAC with a sensitivity of 82% and a specificity of 72%. Additional tyrosinase RT-PCR revealed the same sensitivity of 82% and a specificity of 72%. At a median follow-up time of 40 months from first blood sample, peripheral-blood RT-PCR was a significant independent predictor of disease-free survival (DFS) and overall survival (OS; P < .001).

Conclusion US-FNAC is highly accurate and eliminates the need for SLNB in 16% of all SLNB patients. RT-PCR of the aspirate or excised SN does not improve sensitivity or specificity. RT-PCR of blood samples predicts DFS and OS.

published online ahead of print at www.jco.org on November 3, 2008.

Supported by Deutsche Krebshilfe (Grant No. 70-2791-Vo I).

C.A.V. and G.S.-H. contributed equally to this work.

Presented in part at the Melanoma Session of the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

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

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