@article{3192553,
    title = "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",
    author = "Hodak, E. and Sherman, S. and Papadavid, E. and Bagot, M. and Querfeld, and C. and Quaglino, P. and Prince, H. M. and Ortiz-Romero, P. L. and and Stadler, R. and Knobler, R. and Guenova, E. and Estrach, T. and and Patsatsi, A. and Leshem, Y. A. and Prague-Naveh, H. and Berti, E. and and Alberti-Violetti, S. and Cowan, R. and Jonak, C. and Nikolaou, V and and Mitteldorf, C. and Akilov, O. and Geskin, L. and Matin, R. and and Beylot-Barry, M. and Vakeva, L. and Sanches, J. A. and Servitje, O. and and Weatherhead, S. and Wobser, M. and Yoo, J. and Bayne, M. and Bates, A. and and Dunnill, G. and Marschalko, M. and Buschots, A. M. and Wehkamp, U. and and Evison, F. and Hong, E. and Amitay-Laish, I and Stranzenbach, R. and and Vermeer, M. and Willemze, R. and Kempf, W. and Cerroni, L. and and Whittaker, S. and Kim, Y. H. and Scarisbrick, J. J. and Cutaneous and Lymphoma Int Consortium",
    journal = "British Journal of Dermatology",
    year = "2021",
    volume = "184",
    number = "3",
    pages = "524-531",
    publisher = "Wiley",
    issn = "0007-0963, 1365-2133",
    doi = "10.1111/bjd.19303",
    abstract = "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."
}