Ultrasonography and Fine-needle Aspiration Cytology in the Preoperative Evaluation of Melanoma Patients Eligible for Sentinel Node Biopsy

Rijk, Maartje C. van; Teertstra, Hendrik J.; Peterse, Johannes L.; Nieweg, Omgo E.; Olmos, Renato A. Valdés; Hoefnagel, Cornelis A.; Kroon, Bin B. R.

doi:10.1245/s10434-006-9106-9

Cited by 68 publications

(40 citation statements)

References 23 publications

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“…When compared to the literature, the sensitivity in our hands (51%) is significantly higher than previously reported rates, which differ from 4% to 39% [24][25][26][27][28][29]. In these relatively small series, Starritt et that high-resolution ultrasound (HRUS) yielded a sensitivity of 12% (2/17) [28].…”

Section: Discussioncontrasting

confidence: 68%

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Voit

Gooskens

Siegel

et al. 2014

European Journal of Cancer

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Background: Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanoma patients is controversial and subject of this study. Methods: Between 2001 and 2010 over 1000 stage I/II consecutive melanoma patients prospectively underwent US-FNAC prior to SN biopsy. All patients underwent lymphoscintigraphy prior to US-FNAC. The Berlin US morphology criteria: Peripheral perfusion (PP), loss of central echoes (LCE) and balloon shaped (BS) were registered. FNAC was performed in case of presence of any of these factors. SN tumour burden was measured according to the Rotterdam criteria. All patients underwent SN or lymph node dissection (LND) in case of positive FNAC. Findings: Mean/median Breslow thickness was 2.58/1.57 mm. Mean/median follow-up was 56/53 months (1-132). SN positivity rate was 21%. US-FNAC Sensitivity was 71% (US only) and 51% (US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). PP, LCE and BS had sensitivity of 69%, 24% and 24% respectively. Sensitivity of (2014) 50, 2280-2288 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m US-FNAC increased with increasing SN tumour burden. PP was an early sign of metastasis (58% in <0.1 mm metastases). Threshold size of a metastasis for FNAC was 0.3 mm. Five-year survival correlated to US-FNAC status (95% in negative and 59% in positive). Interpretation: Ultrasound guided FNAC (US-FNAC) according to the Berlin morphology criteria could correctly identify at least half of all tumour positive sentinel nodes, prior to the surgical SN procedure. Peripheral perfusion is an early sign of metastasis, which is very sensitive, but with lower positive predictive value (PPV). It is responsible for the sensitivity of the procedure. Balloon shape is a sign of advanced metastases, with lower sensitivity, but high PPV. US-FNAC sensitivity correlated with increasing T-stage, ulceration of the primary and increasing SN tumour burden. US-FNAC status accurately predicts survival.

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Section: Discussioncontrasting

confidence: 68%

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Voit

Gooskens

Siegel

et al. 2014

European Journal of Cancer

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“…Our study and those done by Rossi, Hocevar, van Rijk and Sibon were performed without lymphoscintigraphy targeting of the draining nodal basin, whereas the studies by Voit and Sanki were performed after lymphoscintigraphy. [15, 16, 18, 41–43] It is difficult to compare these studies directly since targeting draining nodal basins may affect sensitivity and specificity. Furthermore, the patient and tumor characteristics also vary and can influence the results.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

et al. 2011

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Background Sentinel lymph node biopsy (SLNB) is widely used in melanoma. Identifying nodal involvement preoperatively using high-resolution ultrasound may offer less invasive staging. This study assessed feasibility and staging results of clinically-targeted ultrasound (before lymphoscintigraphy) compared to SLNB. Methods From 2005–2009, 325 patients with melanoma underwent ultrasound before SLNB. We reviewed demographics and histopathologic characteristics, then compared ultrasound and SLNB results. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were determined. Results 325 patients, 58% male; 42% female, median age 58 years (range 18–86) were included. A total of 471 basins were examined with ultrasound. Only 6 patients (1.8%) avoided SLNB by undergoing ultrasound-guided fine needle aspiration of involved nodes, then therapeutic lymphadenectomy. 65 patients (20.4%) had 69 SLNB positive nodal basins; 17 nodal basins from 15 patients with positive ultrasounds were considered true-positive. 45 SLNB positive basins had negative ultrasounds (false-negative). 7 node-positive basins did not undergo ultrasound because of unpredicted drainage. 253 patients with negative SLNBs had negative ultrasounds in 240 nodal basins (true-negative) but false-positive ultrasounds occurred in 40 basins. Overall, sensitivity of ultrasound was 33.8%, specificity 85.7%, PPV 36.5% and NPV 84.2%. Sensitivity and specificity improved somewhat with increasing Breslow depth. Sensitivity was highest for the neck, but specificity was highest for the groin. Conclusions Routine preoperative ultrasound in clinically node-negative melanoma is impractical due to low sensitivity. Selected patients with thick or ulcerated lesions may benefit. Because of variable lymphatic drainage patterns, preoperative ultrasound without lymphoscintigraphic localization will provide incomplete evaluation in many cases.

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“…According to studies done by Voit et al ,17 combined US and FNAC provides important information prior to SLNB in that both procedures identify metastases in the lymph nodes (sensitivity >80%). Although, rare studies have reported very low sensitivity which is attributed to tiny and necrotic lesions,19 20 most authors have emphasised the importance of USG-guided FNAC in the detection of sentinel lymph node metastasis 17–19 21. With a positive cytology of the sentinel node, surgeons can proceed with the direct radical lymph node dissection in patients with melanoma; thereby preventing unnecessary anaesthesia and surgical management as well reduce costs 17.…”

Section: Discussionmentioning

confidence: 99%

FNA diagnosis of malignant melanoma-recurrent and metastatic disease

et al. 2012

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We present a case of a 60-year-old woman with multiple right axillary swellings. Patient had a history of lump with pigmentation over back for which she was operated upon. There was also a nodule over resected scar on back. A final diagnosis of malignant melanoma (recurrent and metastatic to axillary lymph nodes) was rendered with the help of fine-needle aspiration cytology (FNAC). Malignant melanomas are the most lethal of cancers of the skin and are notorious for the great variability of cytological presentation. We discuss the role of FNAC in early diagnosis and prognostication of recurrent and metastatic disease.

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Ultrasonography and Fine-needle Aspiration Cytology in the Preoperative Evaluation of Melanoma Patients Eligible for Sentinel Node Biopsy

Cited by 68 publications

References 23 publications

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

FNA diagnosis of malignant melanoma-recurrent and metastatic disease

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