Evidence map›Paper›PMID 33890195›Full record

ArticleAnnals of surgical oncology2021

Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma.

Richard J Straker, Michael J Carr, Andrew J Sinnamon, Adrienne B Shannon, James Sun, Karenia Landa, Kirsten M Baecher, Christian Wood, Kevin Lynch, Harrison G Bartels and 11 more

Abstract read
PubMed Publisher
In one paragraph

Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
  2. Guideline
  3. Radiotherapy for Merkel cell carcinoma: recommendations from the DEGRO Dermatooncology Working Group.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026
    Article
  4. Article
  5. Primary tumor site for localized Merkel cell carcinoma drives different management strategies without impacting oncologic outcomes.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2023
    Article
  6. Review
  7. Article
  8. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Richard J StrakerDepartment of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
Michael J CarrDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Andrew J SinnamonDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Adrienne B ShannonDepartment of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
James SunDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Karenia LandaDepartment of Surgery, Duke University, Durham, NC, USA.
Kirsten M BaecherDepartment of Surgery, Emory University, Atlanta, GA, USA.
Christian WoodDepartment of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
Kevin LynchDivision of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Harrison G BartelsDivision of Head and Neck Surgical Oncology, Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA.
Robyn PanchaudDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Michael C LoweDepartment of Surgery, Emory University, Atlanta, GA, USA.
Craig L SlingluffDivision of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Mark J JamesonDivision of Head and Neck Surgical Oncology, Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA.
Kenneth TsaiDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Mark B FariesCedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
Georgia M BeasleyDepartment of Surgery, Duke University, Durham, NC, USA.
Vernon SondakDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Giorgos C KarakousisDivision of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
Jonathan S ZagerDepartment of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
John T MiuraDivision of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. John.Miura@pennmedicine.upenn.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSentinel lymph node biopsy (SLNB) is routinely recommended for clinically localized Merkel cell carcinoma (MCC); however, predictors of false negative (FN) SLNB are undefined.

methodsPatients from six centers undergoing wide excision and SLNB for stage I/II MCC (2005-2020) were identified and were classified as having either a true positive (TP), true negative (TN) or FN SLNB. Predictors of FN SLNB were identified and survival outcomes were estimated.

resultsOf 525 patients, 28 (5.4%), 329 (62.7%), and 168 (32%) were classified as FN, TN, and TP, respectively, giving an FN rate of 14.3% and negative predictive value of 92.2% for SLNB. Median follow-up for SLNB-negative patients was 27 months, and median time to nodal recurrence for FN patients was 7 months. Male sex (hazard ratio [HR] 3.15, p = 0.034) and lymphovascular invasion (LVI) (HR 2.22, p = 0.048) significantly correlated with FN, and increasing age trended toward significance (HR 1.04, p = 0.067). The 3-year regional nodal recurrence-free survival for males >75 years with LVI was 78.5% versus 97.4% for females ≤75 years without LVI (p = 0.009). Five-year disease-specific survival (90.9% TN vs. 51.3% FN, p < 0.001) and overall survival (69.9% TN vs. 48.1% FN, p = 0.035) were significantly worse for FN patients.

conclusionFailure to detect regional nodal microscopic disease by SLNB is associated with worse survival in clinically localized MCC. Males, patients >75 years, and those with LVI may be at increased risk for FN SLNB. Consideration of increased nodal surveillance following negative SLNB in these high-risk patients may aid in early identification of regional nodal recurrences.

Indexed as

Carcinoma, Merkel CellSentinel Lymph NodeSkin NeoplasmsFemaleHumansLymphatic MetastasisMaleNeoplasm Recurrence, LocalSentinel Lymph Node Biopsy

Identifiers

PMID33890195

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.