Lymph node imaging in patch/plaque mycosis fungoides; enlarged LN are infrequent but lymphomatous nodal involvement may occur and upstage patients to advanced disease

Abstract

Given the lack of unanimity in guideline recommendations for imaging in early mycosis fungoides (MF), we sought to assess the yield of scan imaging in newly diagnosed MF patients with patch/plaque lesions only in the PROCLIPI study. 583 patients presented with skin patches &/or plaques without evidence of advanced skin lesions with a median MSWAT of 11 (range: 1–120); 483 classical MF, 94 folliculotropic MF (FMF) and 6 pagetoid reticulosis. Only 16 (2.7%) patients had enlarged (≥15 mm) lymph nodes (LN) detected by clinical examination. 13 patients had a subsequent imaging scan but in 5 no enlarged LN were detected. In total 229 (39.3%) patients had an imaging scan with enlarged LN (≥15 mm) detected in 31/229 patients (13.5%) at a median of 2 nodal regions (range: 1–5 of possible 8 regions (6 peripheral:left/right cervical, axillary & inguinal, 2 central:thoracic & intrabdominal. The median MSWAT of those with normal LN imaging was 11 vs 33 in those with enlarged LN, p = 0.0002.