The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease

Multi-center, retrospective study of 151 patients

Yasuhiro Fujisawa, Koji Yoshino, Yoshio Kiyohara, Takafumi Kadono, Yozo Murata, Hisashi Uhara, Naohito Hatta, Uchi Hiroshi, Shigeto Matsushita, Tatsuya Takenouchi, Toshihiko Hayashi, Manabu Fujimoto, Kuniaki Ohara

Research output: Contribution to journalArticle

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Abstract

Background: 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. Objective: The main objective of this study is to assess the role of SLNB in patients with iEMPD. Materials and methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)38-42
Number of pages5
JournalJournal of Dermatological Science
Volume79
Issue number1
DOIs
Publication statusPublished - Jul 1 2015

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Extramammary Paget's Disease
Sentinel Lymph Node Biopsy
Biopsy
Retrospective Studies
Tumors
Neoplasm Metastasis
Dissection
Neoplasms
Survival
cyhalothrin
Odds Ratio
Lymphadenopathy
Surgery
Carcinoma in Situ

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Molecular Biology
  • Dermatology

Cite this

The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease : Multi-center, retrospective study of 151 patients. / Fujisawa, Yasuhiro; Yoshino, Koji; Kiyohara, Yoshio; Kadono, Takafumi; Murata, Yozo; Uhara, Hisashi; Hatta, Naohito; Hiroshi, Uchi; Matsushita, Shigeto; Takenouchi, Tatsuya; Hayashi, Toshihiko; Fujimoto, Manabu; Ohara, Kuniaki.

In: Journal of Dermatological Science, Vol. 79, No. 1, 01.07.2015, p. 38-42.

Research output: Contribution to journalArticle

Fujisawa, Y, Yoshino, K, Kiyohara, Y, Kadono, T, Murata, Y, Uhara, H, Hatta, N, Hiroshi, U, Matsushita, S, Takenouchi, T, Hayashi, T, Fujimoto, M & Ohara, K 2015, 'The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease: Multi-center, retrospective study of 151 patients', Journal of Dermatological Science, vol. 79, no. 1, pp. 38-42. https://doi.org/10.1016/j.jdermsci.2015.03.014
Fujisawa, Yasuhiro ; Yoshino, Koji ; Kiyohara, Yoshio ; Kadono, Takafumi ; Murata, Yozo ; Uhara, Hisashi ; Hatta, Naohito ; Hiroshi, Uchi ; Matsushita, Shigeto ; Takenouchi, Tatsuya ; Hayashi, Toshihiko ; Fujimoto, Manabu ; Ohara, Kuniaki. / The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease : Multi-center, retrospective study of 151 patients. In: Journal of Dermatological Science. 2015 ; Vol. 79, No. 1. pp. 38-42.
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T1 - The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease

T2 - Multi-center, retrospective study of 151 patients

AU - Fujisawa, Yasuhiro

AU - Yoshino, Koji

AU - Kiyohara, Yoshio

AU - Kadono, Takafumi

AU - Murata, Yozo

AU - Uhara, Hisashi

AU - Hatta, Naohito

AU - Hiroshi, Uchi

AU - Matsushita, Shigeto

AU - Takenouchi, Tatsuya

AU - Hayashi, Toshihiko

AU - Fujimoto, Manabu

AU - Ohara, Kuniaki

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N2 - Background: 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. Objective: The main objective of this study is to assess the role of SLNB in patients with iEMPD. Materials and methods: 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. Results: 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). Conclusion: 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.

AB - Background: 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. Objective: The main objective of this study is to assess the role of SLNB in patients with iEMPD. Materials and methods: 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. Results: 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). Conclusion: 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.

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