› Forums › General Melanoma Community › Disease mgmt with positive sentinel lymph node
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POW.
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- January 6, 2014 at 6:36 pm
When Is a Completion ALND Necessary in the Presence of a Positive Sentinel Node?
Eur. J. Cancer 2013 Dec 10;[EPub Ahead of Print], A Suyoi, SK Bains, A Kothari, M Douek, O Agbaje, H Hamed, I Fentiman, S Pinder, AD Purushotham
Research · January 02, 2014TAKE-HOME MESSAGE
- This retrospective study from the UK examined 155 patients undergoing completion ALND after positive sentinel lymph node biopsy. Patients with macrometastasis (> 2 mm) in the sentinel node had a 35% likelihood of further axillary disease on completion surgery vs a 10% likelihood in those with micrometastasis (< 2 mm).
- The authors suggest that this adds further evidence supporting the avoidance of completion ALND in patients with micrometastases.
– Richard Bambury, MD
ABSTRACT
Background
The management of the axilla in the presence of positive sentinel lymph node (SLN) remains controversial. Many centres forgo completion axillary lymph node dissection (cALND) in the presence of micrometastatic disease. The American College of Surgeons Oncology Group (ACOSOG) Z0011 trialists argue for extending this to macrometastasis. The aim of this study was to correlate tumour burden in SLNs with that in the residual lymph node basin to determine the likelihood of residual disease in patients with micro- and macrometastasis in the SLN.
Methods
Patients who underwent cALND following a positive SLN were analysed for histopathological features of the primary tumour and burden of axillary disease.
Results
Of 155 patients, 115 (74%) had macrometastases and 40 (26%) micrometastases in the SLNs. Residual axillary disease was detected in 55/155 (35%) patients with macrometastases and 4/40 (10%) with micrometastases. Generally, with increasing size of metastasis in the SLN there was an increasing risk of further disease in residual lymph nodes. Logistic regression analysis showed increased odds ratios for further disease for all groups when compared with the <2 mm (micrometastasis) SLN group.
Conclusion
Patients may be advised to forgo cALND where the SLN contains isolated tumour cells or micrometastasis. Recommendations for proceeding to cALND can be based on the size of metastasis in the SLN, which relates to the risk of further disease in the residual axillary lymph nodes and subsequent regional recurrence.
European Journal of CancerWhen Is a Completion Axillary Lymph Node Dissection Necessary in the Presence of a Positive Sentinel Lymph Node?
Eur. J. Cancer 2013 Dec 10;[EPub Ahead of Print], A Suyoi, SK Bains, A Kothari, M Douek, O Agbaje, H Hamed, I Fentiman, S Pinder, AD Purushotham
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- January 7, 2014 at 6:09 am
They are currently looking at that in the US through the MSLT 2 trial. I was offered this trial but after reading the MSLT 1 results, which is a very interesting read, I elected to have removal of inguinal nodes. They were clear.
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- January 8, 2014 at 1:41 am
STATISTICS ALERT!!!!!!
If comparing the percent of spread from the initial SNB for macro vs micromets – did anyone notice that for micromets the ratio used was 115 (number of patents with SNB macromets) / 155 (total number of patients in the trial) whereas for micromets the numbers were 4 / 40 (total number of micromet SNB patients that had spread beyond the SNB).
The correct numbers SHOULD compare apples to apples ex.
55 (residual disease w/ SNB MACROmets) / 115 (macromets in SNB) = 47.8% compared to
4 (residual disease w/ SNB MICROmets) / 40 (micromets in SNB) = 10%.
THIS WILL SCEW THE DATA!
For starters the first statistic compared residual disease in patients with macromets in thier SNB to the total number of patients in the study, thus the 55/155 = 35%. I thought this was a typo until I recalculated the information and came up with a profoundly different result.
The second number doesn't follow the same statistical comparison! Instead they compare 4/40 or the number of patients who had residual disease to the numbers of patients with micromets to their SNB, NOT THE TOTAL NUMBER OF PATIENTS LIKE THE FIRST STATISTIC!
Either compare 55/155 AND 4/155 (which doesn't make sense) OR what makes for a better comparison is 55/115 AND 4/40. Thus of the patients with residual disease, how many had macromets vs. micromets in their SNB instead of comparing how many had residual disease out of the entire group of 155.
OMG – I can't believe something as glaring made it past peer review to be published……
If anything it provided stronger evidence that macromets in the SNB are worse for prognosis than micromets which everyone pretty much knew according to the 2010 staging criteria.
The 35% quoted in the study is actually 47.8% when you analyze it properly for what they were looking for. The next question is wether or not this is statistically significant or not, and if the study was of a large enough sample size to be valid versus random. Next would be, it repeatable at other reputable institutions with same study design. If so, did they get similar results or something totally different.
Am I wrong here?
It's also why I read critically and seriously look at the proper use of statistics. Activists commonly misuse studies by applying the same bad math or quote inadequetly vetted "scientific" publications, most of which goes unchalleneged……. The media rarely does their due diligence and hollywood mouthpieces are even worse…… Use our brains and common sense……. Sorry for the venting but our county council passed a devastating bill here in Hawaii even though solid peer reviewed science determined otherwise, based on these tactics from a very vocal minority……
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- January 8, 2014 at 1:41 am
STATISTICS ALERT!!!!!!
If comparing the percent of spread from the initial SNB for macro vs micromets – did anyone notice that for micromets the ratio used was 115 (number of patents with SNB macromets) / 155 (total number of patients in the trial) whereas for micromets the numbers were 4 / 40 (total number of micromet SNB patients that had spread beyond the SNB).
The correct numbers SHOULD compare apples to apples ex.
55 (residual disease w/ SNB MACROmets) / 115 (macromets in SNB) = 47.8% compared to
4 (residual disease w/ SNB MICROmets) / 40 (micromets in SNB) = 10%.
THIS WILL SCEW THE DATA!
For starters the first statistic compared residual disease in patients with macromets in thier SNB to the total number of patients in the study, thus the 55/155 = 35%. I thought this was a typo until I recalculated the information and came up with a profoundly different result.
The second number doesn't follow the same statistical comparison! Instead they compare 4/40 or the number of patients who had residual disease to the numbers of patients with micromets to their SNB, NOT THE TOTAL NUMBER OF PATIENTS LIKE THE FIRST STATISTIC!
Either compare 55/155 AND 4/155 (which doesn't make sense) OR what makes for a better comparison is 55/115 AND 4/40. Thus of the patients with residual disease, how many had macromets vs. micromets in their SNB instead of comparing how many had residual disease out of the entire group of 155.
OMG – I can't believe something as glaring made it past peer review to be published……
If anything it provided stronger evidence that macromets in the SNB are worse for prognosis than micromets which everyone pretty much knew according to the 2010 staging criteria.
The 35% quoted in the study is actually 47.8% when you analyze it properly for what they were looking for. The next question is wether or not this is statistically significant or not, and if the study was of a large enough sample size to be valid versus random. Next would be, it repeatable at other reputable institutions with same study design. If so, did they get similar results or something totally different.
Am I wrong here?
It's also why I read critically and seriously look at the proper use of statistics. Activists commonly misuse studies by applying the same bad math or quote inadequetly vetted "scientific" publications, most of which goes unchalleneged……. The media rarely does their due diligence and hollywood mouthpieces are even worse…… Use our brains and common sense……. Sorry for the venting but our county council passed a devastating bill here in Hawaii even though solid peer reviewed science determined otherwise, based on these tactics from a very vocal minority……
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- January 8, 2014 at 1:41 am
STATISTICS ALERT!!!!!!
If comparing the percent of spread from the initial SNB for macro vs micromets – did anyone notice that for micromets the ratio used was 115 (number of patents with SNB macromets) / 155 (total number of patients in the trial) whereas for micromets the numbers were 4 / 40 (total number of micromet SNB patients that had spread beyond the SNB).
The correct numbers SHOULD compare apples to apples ex.
55 (residual disease w/ SNB MACROmets) / 115 (macromets in SNB) = 47.8% compared to
4 (residual disease w/ SNB MICROmets) / 40 (micromets in SNB) = 10%.
THIS WILL SCEW THE DATA!
For starters the first statistic compared residual disease in patients with macromets in thier SNB to the total number of patients in the study, thus the 55/155 = 35%. I thought this was a typo until I recalculated the information and came up with a profoundly different result.
The second number doesn't follow the same statistical comparison! Instead they compare 4/40 or the number of patients who had residual disease to the numbers of patients with micromets to their SNB, NOT THE TOTAL NUMBER OF PATIENTS LIKE THE FIRST STATISTIC!
Either compare 55/155 AND 4/155 (which doesn't make sense) OR what makes for a better comparison is 55/115 AND 4/40. Thus of the patients with residual disease, how many had macromets vs. micromets in their SNB instead of comparing how many had residual disease out of the entire group of 155.
OMG – I can't believe something as glaring made it past peer review to be published……
If anything it provided stronger evidence that macromets in the SNB are worse for prognosis than micromets which everyone pretty much knew according to the 2010 staging criteria.
The 35% quoted in the study is actually 47.8% when you analyze it properly for what they were looking for. The next question is wether or not this is statistically significant or not, and if the study was of a large enough sample size to be valid versus random. Next would be, it repeatable at other reputable institutions with same study design. If so, did they get similar results or something totally different.
Am I wrong here?
It's also why I read critically and seriously look at the proper use of statistics. Activists commonly misuse studies by applying the same bad math or quote inadequetly vetted "scientific" publications, most of which goes unchalleneged……. The media rarely does their due diligence and hollywood mouthpieces are even worse…… Use our brains and common sense……. Sorry for the venting but our county council passed a devastating bill here in Hawaii even though solid peer reviewed science determined otherwise, based on these tactics from a very vocal minority……
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- January 8, 2014 at 2:50 am
Hey, Kim- you've got another statistics geek here ( 😉
You're absolutely right. Good catch! Shame on the authors, the editors AND on Richard Bambury, MD who wrote the "Take Home Message".
Actually, the more I think about it, does this paper even have anything to do with melanoma? There is no mention of melanoma in the abstract and the senior author has lots of publications about breast cancer.
Let's just relegate this one to the ash heap of history.
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- January 8, 2014 at 2:50 am
Hey, Kim- you've got another statistics geek here ( 😉
You're absolutely right. Good catch! Shame on the authors, the editors AND on Richard Bambury, MD who wrote the "Take Home Message".
Actually, the more I think about it, does this paper even have anything to do with melanoma? There is no mention of melanoma in the abstract and the senior author has lots of publications about breast cancer.
Let's just relegate this one to the ash heap of history.
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- January 8, 2014 at 2:50 am
Hey, Kim- you've got another statistics geek here ( 😉
You're absolutely right. Good catch! Shame on the authors, the editors AND on Richard Bambury, MD who wrote the "Take Home Message".
Actually, the more I think about it, does this paper even have anything to do with melanoma? There is no mention of melanoma in the abstract and the senior author has lots of publications about breast cancer.
Let's just relegate this one to the ash heap of history.
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- January 9, 2014 at 3:17 pm
Well, maybe you should be telling the practice update people or the corresponding author of this article your issues with what they say.
Here is the contact page for practice update:
http://help.elsevier.com/app/ask_aer/p/8398
Here is the url for the abstract, with author info:
http://www.ejcancer.com/article/S0959-8049%2813%2901020-4/abstract
And finally, lymph node involvement is part of melanoma, so I think this article is relevant, regardless of what kind of cancer it was written about originally. How did you determine this was about breast cancer? I don't see any evidence of that.
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- January 9, 2014 at 3:17 pm
Well, maybe you should be telling the practice update people or the corresponding author of this article your issues with what they say.
Here is the contact page for practice update:
http://help.elsevier.com/app/ask_aer/p/8398
Here is the url for the abstract, with author info:
http://www.ejcancer.com/article/S0959-8049%2813%2901020-4/abstract
And finally, lymph node involvement is part of melanoma, so I think this article is relevant, regardless of what kind of cancer it was written about originally. How did you determine this was about breast cancer? I don't see any evidence of that.
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- January 9, 2014 at 4:12 pm
Like most of the people here, I try very hard to only share information that I have good reason to believe is true and correct. I no longer believe that the data or the conclusions in this paper are true or correct so I, personally, disavow it.
Not only are the statistics all screwed up, as Kim pointed out, but according to the European Journal of Oncologoy this is a "Corrected Proof published online 12 December 2013" from a paper orignially submitted last May. In all that time with all those revisions and the addition of one other author, NOBODY checked those statistics??!! Given that degree of unprofessionalism on the part of all of the authors, editors and reviewers, I wouldn't bother wasting my time informing any of them about the error. I also disagree with how they expressed their conclusions. So regardless of which cancer this paper refers to, it does not meet my standards.
If you trust their information and want to incorporate it into your decision-making, by all means do so. But I will wait for something more reliable about CLND and melanoma to be published before I mention the topic again.
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- January 9, 2014 at 4:12 pm
Like most of the people here, I try very hard to only share information that I have good reason to believe is true and correct. I no longer believe that the data or the conclusions in this paper are true or correct so I, personally, disavow it.
Not only are the statistics all screwed up, as Kim pointed out, but according to the European Journal of Oncologoy this is a "Corrected Proof published online 12 December 2013" from a paper orignially submitted last May. In all that time with all those revisions and the addition of one other author, NOBODY checked those statistics??!! Given that degree of unprofessionalism on the part of all of the authors, editors and reviewers, I wouldn't bother wasting my time informing any of them about the error. I also disagree with how they expressed their conclusions. So regardless of which cancer this paper refers to, it does not meet my standards.
If you trust their information and want to incorporate it into your decision-making, by all means do so. But I will wait for something more reliable about CLND and melanoma to be published before I mention the topic again.
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- January 9, 2014 at 4:12 pm
Like most of the people here, I try very hard to only share information that I have good reason to believe is true and correct. I no longer believe that the data or the conclusions in this paper are true or correct so I, personally, disavow it.
Not only are the statistics all screwed up, as Kim pointed out, but according to the European Journal of Oncologoy this is a "Corrected Proof published online 12 December 2013" from a paper orignially submitted last May. In all that time with all those revisions and the addition of one other author, NOBODY checked those statistics??!! Given that degree of unprofessionalism on the part of all of the authors, editors and reviewers, I wouldn't bother wasting my time informing any of them about the error. I also disagree with how they expressed their conclusions. So regardless of which cancer this paper refers to, it does not meet my standards.
If you trust their information and want to incorporate it into your decision-making, by all means do so. But I will wait for something more reliable about CLND and melanoma to be published before I mention the topic again.
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- January 9, 2014 at 5:01 pm
I understand that you don't agree with the statistics, but don't get why you wouldn't want to make this known to the people responsible.
And if this is a criticism of my posting of this article, which it appears to be, not all of us have the expertise to determine the accuracy of what is published. And I personally don't know if you are correct in your criticism of this article. So, readers of this forum will have to make up their own minds as to who to believe: a poster on an internet forum or people who do research in this field. Not saying they can't be wrong, but it leaves us with a puzzling situation.
I intend to keep posting articles that appear to have some bearing on melanoma. Some people will find them helpful, even if you don't.
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- January 9, 2014 at 5:01 pm
I understand that you don't agree with the statistics, but don't get why you wouldn't want to make this known to the people responsible.
And if this is a criticism of my posting of this article, which it appears to be, not all of us have the expertise to determine the accuracy of what is published. And I personally don't know if you are correct in your criticism of this article. So, readers of this forum will have to make up their own minds as to who to believe: a poster on an internet forum or people who do research in this field. Not saying they can't be wrong, but it leaves us with a puzzling situation.
I intend to keep posting articles that appear to have some bearing on melanoma. Some people will find them helpful, even if you don't.
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- January 9, 2014 at 5:01 pm
I understand that you don't agree with the statistics, but don't get why you wouldn't want to make this known to the people responsible.
And if this is a criticism of my posting of this article, which it appears to be, not all of us have the expertise to determine the accuracy of what is published. And I personally don't know if you are correct in your criticism of this article. So, readers of this forum will have to make up their own minds as to who to believe: a poster on an internet forum or people who do research in this field. Not saying they can't be wrong, but it leaves us with a puzzling situation.
I intend to keep posting articles that appear to have some bearing on melanoma. Some people will find them helpful, even if you don't.
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- January 9, 2014 at 5:14 pm
Since you posted under the name "Anonymous" how could I possibly be responding to you, personally? A lot of people post under the name "Anonymous"– even more than one poster in a thread. I wasn't criticizing you at all.
I love it when people find interesting and relevent articles about melanoma and share them with us. Please don't stop doing that. I was only saying that, while I originally refered people to this abstract, on further consideration I do not trust their data or conclusions. Naturally, everybody else is free to think what they will.
Hey! If anyone ever wondered about what goes on at scientific conferences– this is what it is like. Difficulty seperating the wheat from the chaff, raising picky but (perhaps) important objections, hurt feelings, apologies, the whole ball of wax. (LOL!)
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- January 9, 2014 at 5:14 pm
Since you posted under the name "Anonymous" how could I possibly be responding to you, personally? A lot of people post under the name "Anonymous"– even more than one poster in a thread. I wasn't criticizing you at all.
I love it when people find interesting and relevent articles about melanoma and share them with us. Please don't stop doing that. I was only saying that, while I originally refered people to this abstract, on further consideration I do not trust their data or conclusions. Naturally, everybody else is free to think what they will.
Hey! If anyone ever wondered about what goes on at scientific conferences– this is what it is like. Difficulty seperating the wheat from the chaff, raising picky but (perhaps) important objections, hurt feelings, apologies, the whole ball of wax. (LOL!)
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- January 9, 2014 at 5:14 pm
Since you posted under the name "Anonymous" how could I possibly be responding to you, personally? A lot of people post under the name "Anonymous"– even more than one poster in a thread. I wasn't criticizing you at all.
I love it when people find interesting and relevent articles about melanoma and share them with us. Please don't stop doing that. I was only saying that, while I originally refered people to this abstract, on further consideration I do not trust their data or conclusions. Naturally, everybody else is free to think what they will.
Hey! If anyone ever wondered about what goes on at scientific conferences– this is what it is like. Difficulty seperating the wheat from the chaff, raising picky but (perhaps) important objections, hurt feelings, apologies, the whole ball of wax. (LOL!)
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- January 9, 2014 at 3:17 pm
Well, maybe you should be telling the practice update people or the corresponding author of this article your issues with what they say.
Here is the contact page for practice update:
http://help.elsevier.com/app/ask_aer/p/8398
Here is the url for the abstract, with author info:
http://www.ejcancer.com/article/S0959-8049%2813%2901020-4/abstract
And finally, lymph node involvement is part of melanoma, so I think this article is relevant, regardless of what kind of cancer it was written about originally. How did you determine this was about breast cancer? I don't see any evidence of that.
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