Lymphatic invasion and the Shields index in melanoma metastases predicting

Publication date: Available online 13 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Zorica Špirić, Mirela Erić, Živka Eri
IntroductionFindings of the prognostic significance of lymphatic invasion are contradictory. In order to find out as efficient cutaneous melanoma metastasis predictor as possible Shields et al. have created a new prognostic index. The aim of this study was to examine if the lymphatic invasion analysis and the Shields index calculation can be used in predicting lymph nodes status in patients with cutaneous melanoma.MethodsLymphatic invasion of the 100 melanoma specimens was detected through the use of dual immunohistochemistry staining for lymphatic endothelial marker D2-40 and for melanoma cells S-100. The Shields index was calculated as a logarithm by multiplying the melanoma thickness, square of peritumoural lymphatic vessel density and the number 2 for present lymphatic invasion.ResultsThere was no statistically significant difference between lymph node metastatic and nonmetastatic melanomas regarding the lymphatic invasion. Metastatic melanomas showed a significantly higher Shields index value compared to nonmetastatic melanomas (p=0.00). Area under the ROC curve (AUC) proved that the Shields index (AUC=0.86, 95% confidence interval (CI) 0.79-0.93, p=0.00) was the most accurate predictor of lymph node status, followed by the melanoma thickness (AUC=0.76, 95%CI 0.67-0.86, p=0.00) and American Joint Committee on Cancer staging (AUC=0.75, 95%CI 0.66-0.85, p=0.00), while lymphatic invasion was not successful (AUC=0.56, 95%CI 0.45-0.67, p=0.31). The Shields index achieved 81.3% sensitivity and 75% specificity (cut-off mean value).ConclusionsOur findings show that D2-40/S-100 immunohistochemical analysis of lymphatic invasion cannot be used for the lymph node status predicting, while the Shields index calculation predicts disease outcome more accurately than the melanoma thickness and AJCC staging.



http://ift.tt/2rkURoM

http://ift.tt/2rBC8Vd