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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, E1
  • Sherman, S1
  • Papadavid, E2
  • Bagot, M3
  • Querfeld, C4
  • Quaglino, P5
  • Prince, H M6
  • Ortiz-Romero, P L7
  • Stadler, R8
  • Knobler, R9
  • Guenova, E10
  • Estrach, T11
  • Patsatsi, A12
  • Leshem, Y A1
  • Prague-Naveh, H1
  • Berti, E13
  • Alberti-Violetti, S13
  • Cowan, R14
  • Jonak, C9
  • Nikolaou, V2
  • And 28 more
  • 1 Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. , (Israel)
  • 2 Athens University Medical School, Athens, Greece. , (Greece)
  • 3 Hospital St Louis, Paris, France. , (France)
  • 4 City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA.
  • 5 Dermatologic Clinic, University of Turin Medical School, Turin, Italy. , (Italy)
  • 6 Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia. , (Australia)
  • 7 Department of Dermatology, Hospital 12 de Octubre, Medical School, University Complutense, Madrid, Spain. , (Spain)
  • 8 Johannes Wesling University Medical Centre, Minden, Germany. , (Germany)
  • 9 Department of Dermatology, Medical University of Vienna, Vienna, Austria. , (Austria)
  • 10 University Hospital Zurich, Zurich, Switzerland. , (Switzerland)
  • 11 Hospital Clinico, University of Barcelona, Barcelona, Spain. , (Spain)
  • 12 Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. , (Greece)
  • 13 University of Milan, Milan, Italy. , (Italy)
  • 14 Christie Hospital, Manchester, UK.
  • 15 HELIOS Klinikum Hildesheim GmbH, University Medical Centre Göttingen, Göttingen, Germany. , (Germany)
  • 16 University of Pittsburgh School of Medicine, Pennsylvania, PA, USA.
  • 17 University of Columbia, New York, NY, USA.
  • 18 Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • 19 CHU Hospital de Bordeaux, Bordeaux, France. , (France)
  • 20 Helsinki University Central Hospital, Helsinki, Finland. , (Finland)
  • 21 University of São Paulo Medical School, São Paulo, SP, Brazil. , (Brazil)
  • 22 Hospital Universatari de Bellvitge, Barcelona, Spain. , (Spain)
  • 23 University Hospital Newcastle, Newcastle, UK.
  • 24 University Hospital Wuerzburg, Wuerzburg, Germany. , (Germany)
  • 25 University Hospital Birmingham, Birmingham, UK.
  • 26 Poole Hospital, Poole, UK.
  • 27 University Hospital Southampton, Southampton, UK.
  • 28 University Hospital Bristol, Bristol, UK.
  • 29 Semmelweis University, Budapest, Hungary. , (Hungary)
  • 30 University Hospital Leuven, Leuven, Belgium. , (Belgium)
  • 31 University Hospital Kiel, Kiel, Germany. , (Germany)
  • 32 Stanford University Medical Center, Stanford, CA, USA.
  • 33 Leiden University Medical Centre, Leiden, the Netherlands. , (Netherlands)
  • 34 Kempf and PFlatz, Histologische Diagnostik, Zurich, Switzerland. , (Switzerland)
  • 35 Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria. , (Austria)
  • 36 St Thomas' Hospital, London, UK.
Published Article
British Journal of Dermatology
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2021
DOI: 10.1111/bjd.19303
PMID: 32574377


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. © 2020 British Association of Dermatologists.

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