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

Voit, Christiane; Gooskens, Saskia L.; Siegel, Petra; Schaefer, Gregor; Schoengen, A.; Röwert, Joachim; Akkooi, Alexander C. J. van; Eggermont, Alexander M.M.

doi:10.1016/j.ejca.2014.05.027

Cited by 51 publications

(42 citation statements)

References 37 publications

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“…Cutaneous melanoma (CM) is the most important skin tumor with increasing incidence in the general population, including young people, with major health and socio-economic implications [1][2][3]. According to Scally et al, in 2013 there were about 76,250 new cases of CM which produced 9180 deaths [4] while according to Li et al about 76,100 new cases were diagnosed in 2014 in the USA with an estimated 9710 expected deaths [5].…”

Section: Introductionmentioning

confidence: 99%

Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results

et al. 2015

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Aim: To study the usefulness of color or power Doppler ultrasound (US) in the pre-surgical evaluation of skin melanoma, and to correlate the Doppler characteristics with the appearance on high frequency ultrasound strain elastography (SE) in the preoperative evaluation of cutaneous melanoma. Materials and method: The study included 42 cutaneous melanoma lesions in 39 adult subjects examined between September 2011 and January 2015. Doppler US features (the presence and aspect of vascularization, and the number of vascular pedicles) and elasticity by strain elastography were evaluated together with the pathological results. Results: The melanoma lesions presented hyper-vascularization, with multiple vascular pedicles and stiff appearance. Significant correlations between the thickness of the tumor, measured histopathologically by the Breslow index, and the degree of vascularization (p=0.0167), and number of vascular pedicles (p=0.0065) were identified. Strong correlations between the SE appearance and vascularization on one hand, and SE and the number of vascular pedicles were also identified (p<0.001). Conclusion: Our study demonstrates that Doppler US and SE offer useful information for THE preoperative evaluation of cutaneous melanoma and may contribute to better defining the long term prognosis.

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Section: Introductionmentioning

confidence: 99%

Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results

et al. 2015

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“…For the current analyses of the US patterns, inclusion was halted after the first 1000 consecutive patients with sufficient follow-up (July 2001-November 2010). Results in the first 400 patients and the follow-up in the first 1000 patients have been reported previously [5][6][7].…”

Section: Patientsmentioning

confidence: 73%

“…Previous results have shown that USguided FNAC can correctly identify from 50% up to 80% in selected subgroups, of all SN metastases, before the surgical excision by SN biopsy [5,6]. Important aspects to achieve these improved results are the use of newly defined US patterns and a low threshold for FNAC [7].…”

Section: Discussionmentioning

confidence: 97%

“…Our experience with preoperative US-guided fine needle aspiration cytology (FNAC) for the early detection of SN involvement in melanoma has previously been described [5][6][7]. Among other results, the pattern of an echo-free island (EFI) was presented.…”

Section: Introductionmentioning

confidence: 88%

“…Our pivotal papers from 2009 to 2010 and obviously the most recent from 2014, reporting the largest prospective collected database on melanoma lymph node US patterns, were not used in the meta-analysis [5][6][7]. In this large database, up to 65% of all metastases could be potentially identified preoperatively [5].…”

Section: Introductionmentioning

confidence: 94%

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Ultrasound of the sentinel node in melanoma patients: echo-free island is a discriminatory morphologic feature for node positivity

Voit

Ophuis

Ulrich³

et al. 2016

Melanoma Research

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Unlike breast and thyroid cancer, the use of ultrasound (US)-guided fine needle aspiration cytology (FNAC) for preoperative staging is limited in melanoma. New US morphology criteria have shown that US-FNAC can correctly identify 50% of all involved sentinel nodes (SN) in melanoma patients before surgical excision. The aim of this study was to examine a new criterion: the echo-free island (EFI). A total of 1000 consecutively staged melanoma patients (Breslow thickness>1 or<1 mm, but ulcerated, Clark IV/V or regressed) scheduled for SN staging underwent preoperative US. US morphology items were assessed: peripheral perfusion, loss of central echoes, balloon shape, and EFI. FNAC was performed in case of suspicious and malignant US patterns. All patients proceeded to undergo an SN biopsy or direct completion lymph node dissection (CLND) (in the case of positive FNAC). In all, 57% of the patients were men. The mean/median Breslow thickness was 2.58/1.57 mm. The mean/median follow-up was 56/53 months. SN was positive in 21%. EFI information was available in 95.3%. EFI was seen in 40 patients (4%). EFI sensitivity was 10.8%, specificity was 97.6%, positive predictive value was 50%, and negative predictive value was 80.2%. EFI was significantly correlated to peripheral perfusion (67.5%). There was no correlation to balloon shape or loss of central echoes. Five-year melanoma-specific survival of patients with EFI was significantly worse: 80% versus 92% when absent. The EFI can be useful in the early detection of SN melanoma metastasis. It is an early sign of involvement and thus associated with a decreased survival.

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Tests to assist in the staging of cutaneous melanoma: a generic protocol

Dinnes

Saleh

Newton‐Bishop

et al. 2017

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To determine the diagnostic accuracy of SLNB for the detection of nodal metastases (in the investigated nodal basin) for the staging of cutaneous invasive melanoma. To determine the diagnostic accuracy of imaging tests for the detection of any metastasis in the primary staging of cutaneous invasive melanoma (i.e. staging at presentation). To determine the diagnostic accuracy of imaging tests for the detection of any metastasis in the staging of recurrence in cutaneous invasive melanoma (i.e. re-staging prompted by findings on routine follow-up). To determine the diagnostic accuracy of imaging tests for the detection of nodal metastases in the staging of cutaneous invasive melanoma. To determine the diagnostic accuracy of imaging tests for the detection of distant metastases in the staging of cutaneous invasive melanoma. These will be estimated separately for those undergoing primary staging and those who have experienced a disease recurrence. Investigation of sources of heterogeneity: We will consider a range of potential sources of heterogeneity for investigation in each individual test review. These may vary between reviews but may include the following. i. Population characteristics: * AJCC stage of disease * Sentinel lymph node status (for imaging studies only) * Clinical nodal status (for imaging studies only) * Primary tumour site (head and neck, trunk, limb, and other) ii. Index test characteristics: * Differences in test positivity thresholds (e.g. for SLNB, the tracer threshold for a 'hot' versus 'cold' node) * Other relevant test characteristics as appropriate to the test under consideration iii. Reference standard characteristics: * Reference standard used (histology, clinical or imaging-based follow-up; concurrent imaging-based reference standard) iv. Study quality: * Consecutive or random sample of participants recruited * Index test interpreted, blinded to the reference standard result * Index test interpreted, blinded to the result of any other index test * Presence of partial or differential verification bias (whereby only a sample of those subject to the index test are verified by the reference test or by the same reference test, with selection dependent on the index test result) * Use of an adequate reference standard * Overall risk of bias We will examine the quality and quantity of research evidence available on the effectiveness of each index test for the primary target condition and make recommendations regarding where further research might be required

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

Cited by 51 publications

References 37 publications

Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results

Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results

Ultrasound of the sentinel node in melanoma patients: echo-free island is a discriminatory morphologic feature for node positivity

Tests to assist in the staging of cutaneous melanoma: a generic protocol

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