Should we be imaging lymph nodes at initial diagnosis of early-stage mycosis fungoides? Results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) international study.

Details

Serval ID
serval:BIB_5DD67738ADEA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Should we be imaging lymph nodes at initial diagnosis of early-stage mycosis fungoides? Results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) international study.
Journal
The British journal of dermatology
Author(s)
Hodak E., Sherman S., Papadavid E., Bagot M., Querfeld C., Quaglino P., Prince H.M., Ortiz-Romero P.L., Stadler R., Knobler R., Guenova E., Estrach T., Patsatsi A., Leshem Y.A., Prague-Naveh H., Berti E., Alberti-Violetti S., Cowan R., Jonak C., Nikolaou V., Mitteldorf C., Akilov O., Geskin L., Matin R., Beylot-Barry M., Vakeva L., Sanches J.A., Servitje O., Weatherhead S., Wobser M., Yoo J., Bayne M., Bates A., Dunnill G., Marschalko M., Buschots A.M., Wehkamp U., Evison F., Hong E., Amitay-Laish I., Stranzenbach R., Vermeer M., Willemze R., Kempf W., Cerroni L., Whittaker S., Kim Y.H., Scarisbrick J.J.
Working group(s)
Cutaneous Lymphoma International Consortium (CLIC) institutions
ISSN
1365-2133 (Electronic)
ISSN-L
0007-0963
Publication state
Published
Issued date
03/2021
Peer-reviewed
Oui
Volume
184
Number
3
Pages
524-531
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Early-stage mycosis fungoides (MF) includes involvement of dermatopathic lymph nodes (LNs) or early lymphomatous LNs. There is a lack of unanimity among current guidelines regarding the indications for initial staging imaging in early-stage presentation of MF in the absence of enlarged palpable LNs.
To investigate how often imaging is performed in patients with early-stage presentation of MF, to assess the yield of LN imaging, and to determine what disease characteristics promoted imaging.
A review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) data.
PROCLIPI enrolled 375 patients with stage T1/T2 MF: 304 with classical MF and 71 with folliculotropic MF. Imaging was performed in 169 patients (45%): 83 with computed tomography, 18 with positron emission tomography-computed tomography and 68 with ultrasound. Only nine of these (5%) had palpable enlarged (≥ 15 mm) LNs, with an over-representation of plaques, irrespectively of the 10% body surface area cutoff that distinguishes T1 from T2. Folliculotropic MF was not more frequently imaged than classical MF. Radiologically enlarged LNs (≥ 15 mm) were detected in 30 patients (18%); only seven had clinical lymphadenopathy. On multivariate analysis, plaque presentation was the sole parameter significantly associated with radiologically enlarged LNs. Imaging of only clinically enlarged LNs upstaged 4% of patients (seven of 169) to at least IIA, whereas nonselective imaging upstaged another 14% (24 of 169). LN biopsy, performed in eight of 30 patients, identified N3 (extensive lymphomatous involvement) in two and N1 (dermatopathic changes) in six.
Physical examination was a poor determinant of LN enlargement or involvement. Presence of plaques was associated with a significant increase in identification of enlarged or involved LNs in patients with early-stage presentation of MF, which may be important when deciding who to image. Imaging increases the detection rate of stage IIA MF, and identifies rare cases of extensive lymphomatous nodes, upstaging them to advanced-stage IVA2.
Pubmed
Web of science
Create date
03/07/2020 18:08
Last modification date
16/03/2021 6:25
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