Gamma probe and ultrasound-guided fine needle aspiration cytology of the sentinel node (GULF) trial

Abstract

PurposeSentinel lymph node biopsy (SLNB) was introduced as a minimally invasive technique for nodal staging. Since associated morbidity is not negligible, it is highly relevant to pursue a more minimally invasive alternative. The purpose of this study was to prospectively evaluate the sensitivity of fine needle aspiration cytology (FNAC) with combined gamma probe and ultrasound (US) guidance in comparison with the gold standard histology of the sentinel node (SN) after SLNB for detecting metastasis.MethodsThe study was designed as a prospective, multicentre, open-label, single-arm trial enrolling patients with newly diagnosed cutaneous melanoma or breast cancer between May 2015 and August 2017. Sample radioactivity was measured using a Mini 900 scintillation monitor. After FNAC, all patients underwent SLNB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated.ResultsAccrual was terminated early following an unplanned interim analysis indicating that a FNAC sensitivity of at least 80% could not be achieved. In total 58 patients of the originally planned 116 patients underwent FNAC with gamma probe and US guidance. There were no true-positive FNAC results, 14 false-negative results and one false-positive result, and thus the sensitivity, specificity, PPV and NPV of FNAC were 0%, 98%, 0% and 75%, respectively. At least 75% of the FNAC samples had a radioactivity signal higher than the background signal.ConclusionFNAC with gamma probe and US guidance is not able to correctly detect metastases in the SN and is therefore not able to replace SLNB. Gamma probe-guided US is a highly accurate method for correctly identifying the SN, which offers possibilities for future research.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-4014-3) contains supplementary material, which is available to authorized users.

Misdiagnosis and treatment of a case of malignant melanoma found in an axillary mass: case report and review

“…Fine-needle aspiration cytology led to the nding of a small malignant round-cell tumor. This procedure is highly useful in arriving at a diagnosis, and patients who undergo this procedure experience less pain than would be involved in tumor resection and biopsy; it also reduces the chance of irritating the tumor (11). In the case under discussion, no primary cutaneous MM was found after body examination.…”

Acral malignant melanoma; emphasis on the primary metastasis and the usefulness of preoperative ultrasound for sentinel lymph node metastasis

“…To evaluate SLN metastasis, SLN biopsy (SLNB) using lymphoscintigraphy with hand-held gamma probe in operating room is widely used 9,12 . The preoperative ultrasound (US), Doppler study, US-guided fine needle aspiration or core biopsy has been introduced to support the SLNB 13–18 . We tried to investigate the usefulness of preoperative US to observe SLN metastasis in acral malignant melanoma.…”