Review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective International Cutaneous Lymphoma Prognostic Index (PROCLIPI) data.
PROCLIPI enrolled 375 patients with T1/T2 MF: 304 classical-MF and 71 folliculotropic-MF. Imaging was performed in 169 patients (45%; 83=CT, 18=PET/CT, 68=U/S); only 9 (5%) had palpable enlarged (≥15mm) LNs, with an over-representation of plaques, irrespective of the 10% body-surface-area cutoff which distinguishes T1 from T2. Folliculotropic-MF was not more frequently imaged than classical-MF. Radiologically enlarged LNs (≥15mm) were detected in 30 patients (18%); only 7 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 (7/169) to at least IIA, whereas non-selective imaging upstaged another 14% (24/169). LN biopsy, performed in 8/30, identified N3 (extensive lymphomatous involvement) in 2, and N1 (dermatopathic changes) in 6.
Physical examination was a poor determinant of LN enlargement/involvement. Presence of plaques was associated with significant increase in identification of enlarged/involved LN in patients with early-stage presentation of MF, which may be important when deciding who to image. Imaging increases detection rate of stage-IIA, and identifies rare cases of extensive lymphomatous nodes, upstaging them to advanced-stage IVA2.
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