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
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
accepted:
30
05
2020
pubmed:
24
6
2020
medline:
3
6
2021
entrez:
24
6
2020
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
OBJECTIVES
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.
METHODS
A review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) data.
RESULTS
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.
CONCLUSIONS
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.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
524-531Subventions
Organisme : Spatz Foundation; Sundown Endowment Legacy (Y.K.)
Organisme : Cancer Research UK Population based Grant, 50763/A18021;J.J.J
Organisme : European Academy Dermatology Venerology Project Grant, 2015
Informations de copyright
© 2020 British Association of Dermatologists.
Références
Olsen E, Vonderheid E, Pimpinelli N et al. Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007; 110:1713-22.
Scarisbrick JJ, Prince HM, Vermeer MH et al. Cutaneous Lymphoma International Consortium study of outcome in advanced stages of mycosis fungoides and Sézary syndrome: effect of specific prognostic markers on survival and development of a prognostic model. J Clin Oncol 2015; 33:3766-73.
National Comprehensive Cancer Network. Practice guidelines in oncology. Primary cutaneous lymphomas. Available at: https://www.nccn.org/professionals/physician_gls/pdf/primary_cutaneous.pdf (last accessed 15 June 2020).
Willemze R, Hodak E, Zinzani PL et al. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29 (Suppl. 4):iv30-40.
Gilson SJ, Whittaker S, Child FJ et al. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas. Br J Dermatol 2019; 180:496-526.
Rosen ST, Gore R, Brennan J et al. Evaluation of computed topography and radionuclide scanning in the staging of cutaneous T-cell lymphoma. Arch Dermatol 1986; 122:884-6.
Kulin PA, Marglin SI, Shuman WP et al. Diagnostic imaging in the initial staging of mycosis fungoides and Sézary syndrome. Arch Dermatol 1990; 126:914-18.
Kim YH, Liu HL, Mraz-Gernhard S et al. Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol 2003; 139:857-66.
Agar NS, Wedgeworth E, Crichton S et al. Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal. J Clin Oncol 2010; 28:4730-9.
Talpur R, Singh L, Daulat S et al. Long-term outcomes of 1,263 patients with mycosis fungoides and Sézary syndrome from 1982 to 2009. Clin Cancer Res 2012; 18:5051-60.
Quaglino P, Pimpinelli N, Berti E et al. Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides: a multicenter, retrospective follow-up study from the Italian Group of Cutaneous Lymphomas. Cancer 2012; 118:5830-9.
Scarisbrick JJ, Quaglino P, Prince HM et al. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients. Br J Dermatol 2019; 181:350-7.
Olsen E, Whittaker S, Kim YH et al. Clinical endpoints and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 2011; 29:2598-607.
Scarisbrick JJ, Hodak E, Bagot M et al. Blood classification and blood response criteria in mycosis fungoides and Sézary syndrome using flow cytometry: recommendations from the EORTC cutaneous lymphoma task force. Eur J Cancer 2018; 93:47-56.
Battistella M, Salléde Chou C, de Bazelaire C et al. Lymph node image-guided core-needle biopsy for cutaneous T-cell lymphoma staging. Br J Dermatol 2016; 175:1397-400.
Bruneton JN, Normand F, Balu-Maestro C et al. Lymphomatous superficial lymph nodes: US detection. Radiology 1987; 165:233-5.
Gerrits CJ, van Overhagen H, van Lom K et al. Ultrasound examination of pathological cervical lymph nodes in patients with non-Hodgkin’s lymphoma and Hodgkin’s disease. Br J Haematol 1994; 88:626-8.
Hodak E, Amitay-laish I, Atzmony L et al. New insights into folliculotropic mycosis fungoides (FMF): a single-center experience. J Am Acad Dermatol 2016; 75:347-55.
van Santen S, Roach RE, van Doom R et al. Clinical staging and prognostic factors in folliculotropic mycosis fungoides. JAMA Dermatol 2016; 152:992-1000.
Spencer A, Gazzani P, Gadvi R et al. Computerized tomography scanning in mycosis fungoides: optimizing the balance between benefit and harm. Br J Dermatol 2018; 178:563-4.