DecisionDx-Melanoma and Sentinel Lymph Node Biopsy: To Do or Not to Do?
DecisionDx-Melanoma and Sentinel Lymph Node Biopsy: To Do or Not to Do?
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DecisionDx-黑色素瘤和前哨淋巴结活检：做还是不做？
DOI：
10.1097/dss.0000000000001741
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Jour,George
中科院分区：
文献类型：
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作者：
Jour,George
我们怀着极大的兴趣阅读了Castle Biosciences关于DecisionDx‐Melanoma的新闻稿，该新闻稿基于2018年2月美国皮肤病学会年会上发表的题为“临床影响研究”和“临床病理因素用于决策”的两项研究。1 DecisionDx-黑色素瘤检测使用肿瘤生物学来预测黑色素瘤复发和前哨淋巴结阳性的个体风险，而不依赖于传统因素。使用来自原发性黑色素瘤的组织，该测试测量了31个基因的表达。这些研究表明，肿瘤厚度和溃疡仍然是促使皮肤科医生进行测试的最重要因素。有趣的是，SLNB阴性状态与推荐该测试的医生数量增加有关。1类似地，先前评估检测试剂盒临床影响的研究显示，至少53%的病例中，基于收到的1类与2类，管理发生了变化。2大多数管理变化包括治疗方式的改变，如增加随访频率和增加成像。2我们发现这些结果很有启发性。然而，我们想知道如何将这种测试作为薄黑色素瘤常规实践中的“标准”测试进行整合。根据美国临床肿瘤学会（ASCO）-外科肿瘤学会（SSO）指南的最新更新，不建议对T1 a（Breslow厚度< 0.8 mm的非溃疡性病变）薄黑素瘤患者进行前哨淋巴结（SLN）活检。只有在与患者充分讨论与手术相关的潜在受益和伤害风险后，才可考虑对T1 b薄黑素瘤（0.8- 1.0 mm Breslow厚度或< 0.8 mm Breslow厚度伴溃疡）进行前哨淋巴结活检。3验证研究的最新数据
We read with great interest the press release by Castle Biosciences concerning DecisionDx‐Melanoma based on 2 studies titled “clinical impact study” and “Utilization of clinic pathologic factors for decision” presented in the American Academy of Dermatology Annual meeting in February 2018. 1 The DecisionDx-Melanoma test uses tumor biology to predict individual risk of melanoma recurrence and sentinel lymph node positivity independent of traditional factors. Using tissue from the primary melanoma, the test measures the expression of 31 genes. 1 These studies showed that tumor thickness and ulceration remain among the most important factor inciting dermatologists to order the test. Interestingly, SLNB-negative status was associated with an increase in the number of physicians recommending the test. 1 Similarly, previous studies assessing the clinical impact of the assay showed a change in management based on the received Class 1 versus 2 in at least 53% of the cases. 2 Most of the change in the management included treatment modality change such as increase in the frequency of the follow-up and increased imaging. 2We find those results instructive. However, we wonder how it would be feasible to integrate this test as a “standard” test in routine practice in thin melanomas. Based on the recent update of the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline, sentinel lymph node (SLN) biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions< 0.8 mm in Breslow thickness). Sentinel lymph node biopsy may be considered for thin melanomas that are T1b (0.8-to 1.0-mm Breslow thickness or< 0.8-mm Breslow thickness with ulceration) only after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. 3 The recent data from validation studies
影响因子：
2.3
作者：
Berger, Adam C.;Davidson, Robert S.;Miller, Alexander R.
通讯作者：
Miller, Alexander R.