The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

Róssi, Carlo; Mocellin, Simone; Scagnet, B; Foletto, Mirto; Vecchiato, Antonella; Pilati, Pierluigi; Tregnaghi, Alberto; Zavagno, G.; Stramare, Roberto; Rubaltelli, Léopoldo; Montesco, Maria Cristina; Borsato, Simonetta; Rubello, Domenico; Lise, Mario

doi:10.1002/jso.10248

Cited by 107 publications

(19 citation statements)

References 23 publications

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“…HRUS as a noninvasive and nonexpensive imaging method is famous and frequently used for the assessment of LNs in melanoma patients [1,3,28,29,30,31]. Because two thirds of all progressive melanoma patients metastasize to the lymphatic route during the first 3 years after primary diagnosis, ultrasound plays a key role in diagnosis, which has been underlined in the newest DeCOG guidelines for CM [32].…”

Section: Discussionmentioning

confidence: 99%

“…), as well as prognosis. During the last 10 years, the superiority of high-resolution ultrasound (HRUS) as a cheap and noninvasive imaging method has been confirmed against palpation in the follow-up situation of patients with CM [1,2,3,4,5]. In a huge recent multi-institutional analysis by Balch et al [6], the impact of the amount of metastases in regional LNs in melanoma patients has been demonstrated impressively, meaning that patients with locoregional LN metastases may have a curable disease depending on the number and size of the involved metastatic LNs.…”

Section: Introductionmentioning

confidence: 99%

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Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

et al. 2013

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Background: Real-time tissue elastography is a new, noninvasive method inultrasonography, differentiating tissues according to their stiffness. Earlier studies have highlighted this technique as a useful diagnostic tool for the detection of noncutaneous malignancies like breast, prostate and thyroid cancer based on the principle that tumor cells present a higher stiffness compared to the adjacent normal tissue. Objective: The purpose of our study was to investigate the value of real-time tissue elastography for the differentiation of benign and metastatic peripheral lymph nodes (LN) in patients with cutaneous melanoma by comparing this technique with conventional B-mode sonography combined with power Doppler sonography (PDS). Methods: In this prospective study, 36 melanoma patients (23 females and 13 males, mean age 62.7 ± 11.1 years) undergoing LN excision at the Department of Dermatology and Allergy, University of Bonn, were included between July 2011 and July 2012. Real-time tissue elastography was planned prior to surgery and histopathological examination. Elasticity images had been qualitatively scored for the proportion of stiff areas from pattern 1-5 (soft to stiff) on the basis of a newly defined system for LNs. Results: A total of 42 LNs have been removed in 36 patients. Of these 42 LNs, 21 carried melanoma cells and 21 were benign LNs. Significant differences in elastographic patterns were found between metastatic and nonmetastatic LNs. In real-time tissue elastography, 19 (90.5%) of 21 metastatic LNs showed a pattern of 3, 4 or 5. Of all benign LNs, 76.2% had a pattern of 1 or 2 in their elastogram. Sensitivity and specificity of B-mode sonography combined with PDS were 80.9 and 76.2%, respectively, 90.5 and 76.2% for elastography and 95.2 and 76.2% for the combined evaluation. Conclusion: An elastography pattern ≥3 was identified as an independent significant factor, predicting a metastatic LN involvement. The combination of elastography with conventional B-mode sonography has the potential to further improve the differentiation between benign and metastatic peripheral LNs in melanoma patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

et al. 2013

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“…According to the goups of Rossi, Kunte, Voit and Sanki, we postulate a threshold way below 5 or 4.5 mm [20,25,43,44]. In the present study, we could identify positive SLNs with a distance of the most centripetally advanced tumor cells from the margin of the lymph node capsule ≥1.3 mm.…”

Section: Discussionmentioning

confidence: 50%

“…The results of previously reported studies on ultrasonography of SLNs in patients with cutaneous melanoma vary largely [20,22,23,24,25,41,42,43]. …”

Section: Discussionmentioning

confidence: 71%

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High-Resolution Ultrasound Combined with Power Doppler Sonography Can Reduce the Number of Sentinel Lymph Node Biopsies in Cutaneous Melanoma

et al. 2011

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Background: Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with cutaneous melanoma. Disadvantages of the SLNB procedure are the overall costs and potential side effects of the operation [J Dtsch Dermatol Ges 2009;7:318–327; J Am Dermatol 2010;62:737–748]. Objective: The purpose of our study was to evaluate whether high-resolution ultrasound combined with power Doppler sonography (PDS) is an appropriate tool for preoperative identification and characterization of sentinel lymph nodes (SLNs) in patients with cutaneous melanoma. Methods: In a prospective study eighty-one consecutive patients with cutaneous melanoma (33 females and 48 males) in whom dissection of SLNs was indicated underwent ultrasound examinations before and after the preoperative lymphoscintigraphy. Results: A total of 170 SLNs (mean 2.1 per patient) were removed and examined by histopathology. High resolution ultrasound combined with PDS correctly identified 2 of 9 positive SLNs. The sensitivity, specifity, positive predictive value, and negative predictive values of ultrasound were 22.2% (95% confidence interval (CI) = 2.8–60.0), 100% (95% CI = 97.7–100.0), 100.0% (95% CI = 15.8–100.0), and 95.8% (95% CI = 91.6–98.3), respectively. Conclusions: Although high-resolution ultrasound combined with PDS cannot substitute SLNB, this technique offers earlier diagnosis of lymph node involvement in a small subgroup of patients (with subcapsular location of metastases), and introduces the possibility to exclude those patients from SLN procedure and directly prepare them for complete lymph node dissection (CLND).

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Ultrasonography Using Simple Diagnostic Criteria vs Palpation for the Detection of Regional Lymph Node Metastases of Melanoma

Saïag¹,

Bernard²,

Beauchet³

et al. 2005

Arch Dermatol

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The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

Cited by 107 publications

References 23 publications

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

High-Resolution Ultrasound Combined with Power Doppler Sonography Can Reduce the Number of Sentinel Lymph Node Biopsies in Cutaneous Melanoma

Ultrasonography Using Simple Diagnostic Criteria vs Palpation for the Detection of Regional Lymph Node Metastases of Melanoma

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