Critical Analysis of the Ultrasonographic Criteria for Diagnosing Lymph Node Metastasis in Patients With Cutaneous Melanoma

Abstract

The purpose of this systematic review of the literature was to evaluate the use of ultrasonography (US) in the assessment of lymph node metastasis in patients with cutaneous melanoma. A multimodal strategy was used, which was mainly based on a PubMed database search. Among the 201 cumulative articles collected (years 1989-2009), 31 were found to match all of the inclusion criteria and to provide a description of the use of US scanning in lymph node melanoma metastasis. Data extracted included the author's name and country, journal and year of publication, prospective or retrospective nature of the study, single-center or multicenter nature of the study, period when US studies were performed, US transducers used, gray scale and color Doppler criteria used for diagnosis, and data on US accuracy. The diagnostic criteria used in the 31 selected articles were critically reviewed, illustrating to the reader the discrepancies and unclear aspects identified. On the basis of this review, the need to establish definitive, clearly defined, and univocal diagnostic criteria to be applied in daily clinical practice as well as to be used in articles to be published is emphasized.

High-resolution color-Doppler ultrasound for the study of skin growths

“…-To evaluate retrospectively the morphological aspects of some skin growths at ultrasound B-mode and colorpower Doppler using a high-frequency transducer [5][6][7][8][9][10][11][12][13][14][15][16][17]; to correlate the results of ultrasound with dermoscopy examination and histological data to identify specific ultrasound patterns to differentiate benign from malignant lesions. -To select melanomas among the malignant lesions, to describe their sonographic pattern, the presence and morphology of vascular signal and to compare their thickness at US with the histological Breslow index and check whether or not our data were combined with data already present in the literature.…”

“…The aim of this study was -To evaluate retrospectively the characteristics of normal skin by ultrasound examinations performed with a high-frequency transducer [5][6][7][8][9][10][11][12][13][14][15][16][17].…”

The utility of elastography and CEUS for the differentiation between benign and malignant cervical lymphadenopaty. Three cases report

“…Signs of malignant lymph nodes are considered to be the hypoechoic and heterogeneous texture, the round shape, the lack of hyperechoic hilum, the ill-defined margins, and the peripheral or mixed pattern of vascularization [4,5]. Until now no absolute criterion has been defined due to the false positive and false negative aspects encountered in normal and pathological lymph nodes [5,6].…”

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

“…In a 2011 meta-analysis, Catalano et al [8] found that 31 out of 201 articles matched their inclusion criteria to provide a description of the use of US scanning for the detection of melanoma lymph node metastases. This compilation of articles showed that, in contrast to older systems, modern high-resolution scanners now allow for recognition of very subtle abnormalities within the lymph node.…”

“…Even if set adequately for detecting slow flow, the scanners used in the past would frequently not have been able to allow for the recognition of relevant signals in malignant lymph nodes, simply because of the low intrinsic sensitivity of those machines [8]. Instead, modern equipment would be very sensitive to slow flow and optimal depiction of the abnormal angiographic architecture of superficial lymph node metastases [8].…”