Lymphovascular Markers in Melanoma Sentinel Lymph Nodes
Stewart G Neill, Grant W Carlson, Andrew J Page, Jason Wang, Cynthia Cohen. Emory University School of Medicine, Atlanta, GA
Background: Cutaneous malignant melanomas principally metastasize to lymph nodes, and sentinel lymph node (SLN) sampling has become a critical facet of melanoma prognosis and treatment. Evidence has shown that melanomas trigger lymphangiogenesis at the tumor-stromal junction and that this process is correlated with SLN metastasis. Further, there is evidence that melanomas may produce premetastatic niches in SLNs through a similar process of influencing lymphangiogenesis. SLNs excised in the treatment of melanomas were retrospectively stained for lymphovascular immunohistochemical markers (CD31, CD34, D2-40) to identify changes in intranodal vascular density and correlate those changes with clinical outcomes.
Design: 65 melanomas with SLN biopsy, clinical follow-up, and adequate paraffin-embedded nodal tissue were studied. Immunohistochemistry for CD31, CD34, and D2-40 was performed. Stained slides were analyzed for microvessel density (MVD) based upon the manual quantitation of vessels within three 20x high-powered fields over “hot spots”. Automated quantitation of staining density and intensity was performed using a Dako ACIS III scanner. Mean MVDs, mean staining percentages (% stain), and mean staining intensities were compared.
Results: 65 melanoma patients included 8 with negative SLNs and recurrence, 26 with negative SLNs and no recurrence, and 31 positive nodes with and without recurrence.
|Number||Mean MVD||% Stain||Intensity||Mean MVD||% Stain||Intensity|
|Negative with recurrence||8||78.5*||50.1||101.4*||9.1||22.5*||69.4*|
|Negative without recurrence||26||117.5*||44.2||84.2*||6.2||13.1*||71.3*|