Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-20253873
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Nomogramas de predição de metástase no linfonodo sentinela em melanoma em uma população do sul do Brasil: um estudo de acurácia

Nomograms for predicting sentinel lymph node metastasis in melanoma in a Southern Brazilian population: an accuracy study

Amarildo Francisco Candiago Júnior; Jefferson Traebert; Eduardo Zanella Cordeiro

http://dx.doi.org/10.1590/0100-6991e-20253873 RCBC, vol.52, e20253873, 2025
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Resumo

Objetivo: A biópsia do linfonodo sentinela é fundamental no estadiamento e prognóstico do melanoma cutâneo quando há indicação de ser realizado. Porém, ainda se obtém alto índice de resultados negativos. Para diminuir a taxa de verdadeiros negativos, centros oncológicos têm desenvolvido nomogramas para melhor estratificar o paciente a ser indicado o procedimento.

Objetivo: Estudar a acurácia de dois nomogramas para o cálculo de probabilidade de positividade do linfonodo sentinela criados pelo Memorial Sloan-Kettering Cancer Center (MSKCC) e pelo Melanoma Institute Australia (MIA) em uma população de pacientes do sul do Brasil.

Métodos: Foi realizado um estudo de acurácia em que foram incluídos dados de 320 pacientes com diagnóstico de melanoma em uma instituição de referência em oncologia de Santa Catarina. Foi calculado o risco de cada paciente submetido à biópsia do linfonodo sentinela pelos nomogramas estudados e comparados com os resultados do exame anatomopatológico. A discriminação dos valores foi feita pelo cálculo da área abaixo da curva da Receiver Operator Curve e assim obtido o valor da acurácia de cada nomograma.

Resultados: O nomograma do MSKCC apresentou acurácia global de 69,05% e o nomograma do MIA de 68,38%.

Conclusão: Os nomogramas não apresentaram graus de acurácia aceitáveis para sua aplicabilidade na população estudada.

Palavras-chave

Melanoma; Metástase de Linfonodo; Biópsia de Linfonodo Sentinela

Abstract

Introduction: Sentinel lymph node biopsy is fundamental for staging and prognostication of cutaneous melanoma when indicated. However, it still yields a high rate of negative results. To reduce the rate of true negatives, oncology centers have developed nomograms to better stratify patients for whom the procedure is recommended.

Objective: To study the accuracy of two nomograms developed by the Memorial Sloan-Kettering Cancer Center (MSKCC) and the Melanoma Institute Australia (MIA) for calculating the probability of sentinel lymph node positivity in a population of patients from southern Brazil.

Methods: An accuracy study was conducted, including data from 320 patients diagnosed with melanoma at a referral oncology institution in Santa Catarina, Brazil. The risk of sentinel lymph node positivity was calculated for each patient using the studied nomograms and compared to the results of histopathological examination. Discrimination was assessed by calculating the area under the Receiver Operating Characteristic (ROC) curve, thereby determining the accuracy of each nomogram.

Results: The MSKCC nomogram demonstrated an overall accuracy of 69.05%, while the MIA nomogram showed an accuracy of 68.38%.

Conclusion: The nomograms did not exhibit acceptable levels of accuracy for application in the studied population.

Keywords

Melanoma; Metástase de Linfonodo; Biópsia de Linfonodo Sentinela

Referências

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Submetido em:
12/12/2024

Aceito em:
06/07/2025

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