Detection of submicroscopic lymph node metastases in patients with melanoma
R. Heller, J. Becker, J. Wasselle, P. Baekey, W. Cruse, K. Wells, C. Cox, B. King and D. S. Reintgen
Department of Surgery, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612.
A cell culture technique was developed to investigate submicroscopic lymph
node metastases in patients with stage 1 or 2 malignant melanoma. Lymph
nodes were isolated from standard dissections and bivalved. Half of the
node was evaluated by routine histopathologic examination, while the other
half was processed and placed into tissue culture. Three hundred
twenty-three lymph nodes were collected from 41 patients. The cell culture
technique identified 155 of 323 lymph nodes containing micrometastases,
while only 20 of 323 lymph nodes tested positive with routine histochemical
processing. Nine patients were upgraded from stage 1 or 2 to stage 3
disease after micrometastases were identified in lymph node cultures.
Identification of melanoma was confirmed by cytologic examination,
immunohistologic staining, and the presence of GD3 ganglioside and 250-kd
glycoprotein melanoma-associated antigens. This study provides evidence
that the culture of lymph nodes is a sensitive method for the detection of
micrometastases. In addition, this procedure may change prognosis and
identify candidates for adjuvant therapies.
