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
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. [Marschalkó, Márta (Nemi betegségek, ...), szerző] Bőr-, Nemikórtani
és Bőronkológiai Klinika (SE / AOK / K); 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.; Cutaneous Lymphoma Int Consortium [Kollaborációs szervezet]
Angol nyelvű Sokszerzős vagy csoportos szerzőségű szakcikk (Folyóiratcikk) Tudományos
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.
