In 13 cases (76%), the estimated likelihood of Sentinel Lymph Node Biopsy positivity reported in the GEP test was in alignment with most recent AJCC guidelines. An average of 15 minutes was noted for providers to explain and order the 31-GEP test.
Clinical Pearls
This retrospective study analyzed the clinical utility of a 31-gene expression profile in 17 newly diagnosed patients with melanoma
Results of the 31-GEP were compared to the frequency of certain dermoscopic features and AJCC clinicopathologic features (tumor thickness, ulceration, mitotic rate)
According to results of the 31-GEP, patients were stratified into four groups: 1a, 1b, 2a, and 2b, with the former two suggesting low risk for recurrence or metastasis and the latter two suggesting high risk for recurrence or metastasis
In 13 cases (76%), the estimated likelihood of Sentinel Lymph Node Biopsy positivity reported in the GEP test was in alignment with most recent AJCC guidelines. An average of 15 minutes was noted for providers to explain and order the 31-GEP test.
Discussion:
There are significant challenges when determining the prognosis and appropriate management of patients with newly diagnosed cutaneous malignant melanoma (CMM). For instance, the majority of melanoma-related deaths occur in patients with sentinel lymph node negative disease who were initially diagnosed with stage I or stage II disease. Thus, there presents a need for additional risk stratification tools in the management of CMM. The use of a 31 gene-expression profiling (31-GEP) test has been shown to accurately identify patients with CMM at higher risk for subsequent metastasis. This retrospective study analyzed the utility of a 31-GEP test when managing CMM while comparing the results of this test to certain clinical features such as dermoscopy findings.
In this study, the results of a 31-GEP test performed on 17 patients with newly diagnosed CMM were compared to frequency of certain dermoscopic features based on a modified three-point checklist and AJCC clinicopathologic features including Breslow depth, ulceration, and mitotic rate. Of the 17 cases, 13 were pathologically confirmed invasive melanomas while 3 were melanoma in-situs and 1 was a pathologically confirmed high grade atypical nevus with unusual cytologic features. The time to explain and order a 31-GEP was also measured in this study.
The average time to explain the 31-GEP to patients as well as order the test was found to be 15 minutes. In 13/17 cases (76%), the likelihood of SLNB positivity predicted by the 31-GEP test was in alignment with the range estimated by the most recent AJCC guidelines. However, there was no statistical significance found between the three dermoscopic features evaluated and the results of the 31-GEP test. The study’s authors concluded this was likely due to a small sample size and larger, more comprehensive studies are needed to better understand whether dermoscopic findings correlate with 31-GEP test results. In summary, the authors of this study support the use of GEP testing in determining the prognosis and consequent management of patients with newly diagnosed CMM.
Comentarios