Lower tumour burden and better overall survival in melanoma patients with regional lymph node metastases and negative preoperative ultrasound

Abstract

BackgroundThe purpose of the study was to evaluate the ability of ultrasound (US) and fine needle aspiration biopsy (FNAB) in reducing the number of melanoma patients requiring a sentinel node biopsy (SNB); to compare the amount of metastatic disease in regional lymph nodes in SNB candidates with clinically uninvolved lymph nodes and of those with US uninvolved lymph nodes; and to compare the overall survival (OS) of both groups.MethodsBetween 2000 and 2007, a SNB was successfully performed in 707 patients with melanoma. The preoperative US of the regional lymph node basins was performed in 405 SNB candidates. In 14 of these patients, the US-guided FNAB was positive and they proceeded directly to lymph node dissection. In 391 patients, the preoperative US was either negative (343 patients) or suspicious (48 patients) (US group). In the remaining 316 patients the preoperative US was not performed (non-US group).ResultsThe proportion of macrometastatic sentinel lymph nodes (SN), number of metastatic lymph nodes per patient and proportion of nonsentinel lymph node metastases were found to be lower in the US group compared to the non-US group. The smaller tumour burden of the US group was reflected in a significantly better OS of patients with SN metastases.ConclusionsThe preoperative US of regional lymph nodes spares some patients with melanoma from undergoing a SNB. Patients with regional metastases and a negative preoperative US have a significantly lower tumour burden in comparison to those with clinically negative lymph nodes, which is also reflected in a better OS.

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

“…Regarding survival, a study by Pilko et al showed lower SN tumour burden and improved survival for US negative patients compared to US positive patients, even in the absence of a positive FNAC [30]. This is in line with our observation that US negative (no suspicious or malignant morphology criteria) patients have the best prognosis compared to PP only with a slightly decreased survival and a low survival rate for BS and/ or LCE ( Fig.…”

The role of ultrasound and ultrasound-guided fine needle aspiration biopsy of lymph nodes in patients with skin tumours

“…Specifically, not only has US examination proved to be a valuable method for pre-operative melanoma staging21, but it is also a valid technique for assessing metastatic lymph nodes during the melanoma follow-up.…”

Ультразвуковое Исследование Лимфатических Узлов И Их Пункционная Аспирационная Биопсия У Больных Опухолями Кожи. Динамическое Наблюдение После Проведенного Лечения

“…Ультразвуковое исследование является ведущим среди методов получения изображений для опреде-ления состояния лимфатических узлов [1]. Особен-но (если не единственно) важное значение имеет УЗИ в установлении метастазирования в отдаленные сроки после лечения меланомы кожи.…”