1 / 22

2017/2018 Sentinel Lymph Node Biopsy in Malignant Melanoma

M Rice, V Valeanu , I Delikonstantinou , E Wilson, A Orlando. 2017/2018 Sentinel Lymph Node Biopsy in Malignant Melanoma. SLNB Surgical Protocol. 1 Pre-op lymphoscintigraphy with radio colloid. 2 Dermal injection with patent blue. 3 WLE of MM scar.

broxanne
Télécharger la présentation

2017/2018 Sentinel Lymph Node Biopsy in Malignant Melanoma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. M Rice, V Valeanu, I Delikonstantinou, E Wilson, A Orlando 2017/2018Sentinel Lymph Node Biopsy in Malignant Melanoma

  2. SLNB Surgical Protocol 1 Pre-op lymphoscintigraphy with radio colloid 2 Dermal injection with patent blue 3 WLE of MM scar 4 Gamma probe guided SLNB (>95% accuracy when performed with dermal injection)

  3. Why Perform SLNB? • A Staging Procedure • Key prognostic indicator in Melanoma and determinant of access to adjuvant therapy • NICE (2015): indicate SLNB in Stage 1B with Breslow >1.0mm • AJCC 8th edition : 0.8mm Breslow or ulcerating lesion • Melanoma Focus Group 2019: pT1b, particularly when: a. Lymphovascular invasion b. Mitotic rate ≥2/mm2

  4. Aims • Continue Annual Audit of SLNB @ NBT • Measure Surgical Outcomes of SLNB @ NBT • Compare practice against NICE guidance Cycle 1 July 2014 – June 2016 Cycle 2 July 2016 – June 2017 Cycle 3 July 2017 – June 2018

  5. Methods • Retrospective review of Medical Records: • Demographics • Timings • Histopathology reports • Outcomes • Patients coding for Melanoma identified from Business Intelligence Services • Electronic notes, Discharge Summaries and ICE reports reviewed • Compare to previous data and guidelines

  6. Results: Case Load 99 90 85 50 Increase in patients seen since last year – 10% Increase in SLNB procedures since last year – 14%

  7. Female • 30.9% 99 Patient identified in 2017 – 2018 Male to Female: 1.41 / 1 • Male • 69.1% Gender Distribution 2014-2016 Gender Distribution 2016-2017 Results: Gender Distribution Male 52.2% Female 47.8% 2015-16 85 patients 2014-15 50 patients • Female • 41% • Male • 59% 90 patients

  8. Results: Age Distribution Average: 64 yrs Median: 60 yrs Average: 59.7 yrs (prev 58.7) Median: 60 yrs Age Distribution 2016-17

  9. Referral Geography 2016/17 Results: Melanoma Referral Geography Referral by Geography 21 15 18

  10. Results: Diagnosis of Primary Lesion • Mainly GPs 4/5 • Reflection education • 3 GPs

  11. Results: Time Targets SWAG Network Skin Cancer SSG Meeting Sept 2017 http://www.swscn.org.uk/wp/wp-content/uploads/2014/11/ https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2017/06/Cancer-Waiting-Times-Annual-Report-201617-1.pdf SWAG_Skin_SSG_Draft_Notes_13092017.pdf

  12. Results: Breslow Thickness Average BT = 2.54 (2.18) Average BT SLNB -VE = 2.43 (2.04) Average BT SLNB +VE = 2.72 (2.17)

  13. Results: Primary MM Site 2016/17 26 4 18

  14. Results: WLE Margins • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Melanoma, version 1.2013. National Comprehensive Cancer Network; Fort Washington, PA: 2013. www.NCCN.org • NICE Melanoma: assessment and management (NG14) . July 2015 https://www.nice.org.uk/guidance/ng14

  15. Results: Sentinel Node Basins 7.6% 54.8% 2.9% 34.6%

  16. Results: Sentinel Node Basins

  17. Results: Sentinel Node Biopsy Status 2017-18 CLND = 22 Performed* 7 declined 1 died 2016-17 CLND = 14 Performed 4 declined * 22 Dissections performed – 2 on different sites of same patient

  18. Results: Complications 2016-17 2016/17 SLNB Complication : 14 cases (17.2%) 2016/17 CLND Complications : 4/11 (36%) 2017-18 2017/18 SLNB Complication : 14 cases (13.7%) 2017/18 CLND Complications : 8/22 (36%) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/666465/SSI_annual_report_NHS_hospitals_2016-17.pdf https://www.nice.org.uk/guidance/cg74/resources/surveillance-report-2017-surgical-site-infections-prevention-and-treatment-2008-nice-guideline-cg74-pdf-5649242244037

  19. Results: Complications • SLNB complications most often occurred in the Groin: 64% - Seroma or Infected Seroma • Completion Dissection complications were most common following Groin Dissection: 50% - Seroma or Infected Seroma

  20. Conclusions • Increase in Overall Case Load (99 vs 85 patients) • Most referrals are from Dermatology and from Gloucester / Cheltenham region • Less Shave Biopsies performed (3% vs 6.6%) • Problem with meeting service time target – reduced surgical capacity for a period, higher number of metastatic cases requiring more complex procedures, reduced surgical team for a period • 14% increase in SLNB procedures performed (97 vs 81) • 36.4% increase in number of lymph node dissections undertaken (22 vs 14) • SLNB Complication rate decreased for 2nd consecutive cycle (13.7% vs 17.2%) • Dissection Complication rate remained the same (36%) – however zero mortality, no major complications, and several unusual complications unlikely to recur

  21. Recommendations • Focus on improving hit rate regarding service time targets – increased surgical capacity and back to a full team. • Be aware of steadily increasing case load year-on-year and account of this in planning future provision

  22. Many Thanks

More Related