The Use of High-Resolution Ultrasonography for Preoperative Detection of Metastases in Sentinel Lymph Nodes of Patients with Cutaneous Melanoma

Kunte, Christian; Schuh, Theda; Eberle, Julia; Baumert, Jens; Konz, Birger; Volkenandt, Matthias; Ruzicka, Thomas; Schmid‐Wendtner, Monika‐Hildegard

doi:10.1111/j.1524-4725.2009.01288.x

Cited by 33 publications

(26 citation statements)

References 28 publications

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“…[12][13][14]38,41,42 Several published reports have described the sensitivity, specificity, and accuracy of US for LN metastases, primarily for breast applications. [12][13][14][15]38,41,42 In patients with breast cancer, the lymphatic drainage pathways are relatively predictable, whereas in patients who have melanoma, the location of the SLNs is more variable. 43,44 This project has confirmed the potential utility of lymphosonography as a lymphatic mapping technique and its ability to localize SLNs even in cases of unpredictable drainage pathways.…”

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confidence: 99%

“…[12][13][14] It has also been found to be a valuable method to guide LN biopsies. 15,16 Although gray scale US, color flow US, and pulsed Doppler imaging have been used alone or in combination to assess LNs for the presence of metastases, US cannot be used for lymphatic mapping (ie, to identify a tumor's SLNs) because mapping requires administration of a tracer (eg, dye or radiopharmaceutical).…”

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confidence: 99%

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Contrast-Enhanced Ultrasound Imaging of Sentinel Lymph Nodes After Peritumoral Administration of Sonazoid in a Melanoma Tumor Animal Model

Goldberg

Merton

Liu

et al. 2011

Journal of Ultrasound in Medicine

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etection and characterization of sentinel lymph nodes (SLNs) are important for the management of patients who have a variety of malignancies, including melanoma, breast, colon, and other cancers. [1][2][3][4] Various techniques and imaging agents have been developed to map lymphatic drainage from tumors, including the use of blue dye with surgical dissection and injection of radiopharmaceuticals followed by evaluation with a gamma camBarry B. Goldberg, MD, Daniel A. Merton, BS, RDMS, Ji-Bin Liu, MD, Flemming Forsberg, PhD, Kaijun Zhang, PhD, Madhukar Thakur, PhD, Stephanie Schulz, PhD, Robin Schanche, BS, George F. Murphy, MD, Scott A. Waldman, MD, PhD Received October 6, 2010, ORIGINAL RESEARCHObjectives-The purpose of this study was to compare lymphosonography (ie, contrast-enhanced ultrasound imaging [US] after interstitial injection of a US contrast agent) for the detection of sentinel lymph nodes (SLNs) in swine with naturally occurring melanoma tumors to lymphoscintigraphy using blue dye-guided surgical dissection as the reference standard. Also, we sought to determine if lymphosonography can be used to characterize SLNs.Methods-Sixty-three swine with 104 melanomas were evaluated. Contrast-specific US was performed after peritumoral injection (1 mL dose) of Sonazoid (GE Healthcare, Oslo, Norway). Lymphoscintigraphy was performed after peritumoral injections of technetium Tc 99m sulfur colloid. Peritumoral injection of 1% Lymphazurin (Ben Venue Labs, Inc, Bedford, OH) was used to guide SLN resection. The accuracy of SLN detection with the two imaging modalities was compared using the McNemar test. The SLNs were qualitatively and quantitatively characterized as benign or malignant based on the lymphosonography results with histopathology and RNA analyses used as the reference standards.Results-Blue dye-guided surgery identified 351 SLNs. Lymphosonography detected 293 SLNs and 11 false-positives, while lymphoscintigraphy detected 231 SLNs and 20 false-positives. The accuracy of SLN detection was 81.8% for lymphosonography, which was significantly higher than the 63.2% achieved with lymphoscintigraphy (P < .0001). The accuracy of lymphosonography for SLN characterization was 80%. When the size of the enhanced SLN was taken into consideration to characterize SLNs, the accuracy was 86%.Conclusions-Lymphosonography is statistically better than lymphoscintigraphy for the detection of SLNs in this animal model. The ability to use lymphosonography as a means to characterize SLNs as benign or malignant is limited.

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Contrast-Enhanced Ultrasound Imaging of Sentinel Lymph Nodes After Peritumoral Administration of Sonazoid in a Melanoma Tumor Animal Model

Goldberg

Merton

Liu

et al. 2011

Journal of Ultrasound in Medicine

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“…These authors hypothesized that the cap corresponded to the region where the melanoma-specific afferent lymphatic vessel enters the lymph node. In our opinion, as also suggested by other authors who could not see the cap phenomenon, 25,31,32 these findings are too subtle to be used in clinical practice, where slight asymmetry of the nodal cortex is not an uncommon finding.…”

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confidence: 66%

“…We take the shape of the lymph node into consideration, being suspicious when oval and even more suspicious when round and not being suspicious if markedly elongated. Some authors consider an L/T ratio of less than 2 suspicious, 8,19,24,25 whereas others, as well as us, con-sider an L/T ratio of less than 1.5 suspicious. 7,18,26 We believe that a threshold of 1.5 increases the rather low specificity of the size criterion.…”

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confidence: 99%

Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

Catalano

Setola

Vallone

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Sonography is being used with increasing frequency in the assessment of locoregional tumor spread in patients with melanoma. Nevertheless, to maximize its practical impact, sonography should be performed with state-of-the-art equipment, by specifically trained operators, and using a careful exploration technique and well-defined diagnostic criteria. In this "how I do it"-type article, we illustrate our practical approach to sonography of cutaneous melanoma. Methods. We first illustrate the basic and advanced technical requirements; then we describe our exploration methods and our image interpretation approach; and finally, we report on our use of sonography as a guidance tool for interventional procedures. Special emphasis is given to methodological and interpretative clues, tricks, and pitfalls. Results. Sonography can be used in the initial staging of patients with melanoma, particularly in the screening of patients scheduled for a sentinel lymph node biopsy procedure. Additionally, sonography can be used during patient follow-up to detect locoregional recurrence earlier than palpation. Conclusions. Sonography plays a growing role in the assessment of the superficial spread of melanoma. Nevertheless, state-of-the-art equipment and careful exploration by trained operators are necessary.

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“…In a recent smaller study including 25 consecutive patients with cutaneous melanoma, Kunte et al [44] evaluated the ability of high-resolution B-mode sonography (without color Doppler sonography) for preoperative identification of SLNs. In 25 patients, 35 SLNs were removed surgically and 6 (17.1%) turned out to be positive by histopathologic examination.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Ultrasound Combined with Power Doppler Sonography Can Reduce the Number of Sentinel Lymph Node Biopsies in Cutaneous Melanoma

et al. 2011

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Background: Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with cutaneous melanoma. Disadvantages of the SLNB procedure are the overall costs and potential side effects of the operation [J Dtsch Dermatol Ges 2009;7:318–327; J Am Dermatol 2010;62:737–748]. Objective: The purpose of our study was to evaluate whether high-resolution ultrasound combined with power Doppler sonography (PDS) is an appropriate tool for preoperative identification and characterization of sentinel lymph nodes (SLNs) in patients with cutaneous melanoma. Methods: In a prospective study eighty-one consecutive patients with cutaneous melanoma (33 females and 48 males) in whom dissection of SLNs was indicated underwent ultrasound examinations before and after the preoperative lymphoscintigraphy. Results: A total of 170 SLNs (mean 2.1 per patient) were removed and examined by histopathology. High resolution ultrasound combined with PDS correctly identified 2 of 9 positive SLNs. The sensitivity, specifity, positive predictive value, and negative predictive values of ultrasound were 22.2% (95% confidence interval (CI) = 2.8–60.0), 100% (95% CI = 97.7–100.0), 100.0% (95% CI = 15.8–100.0), and 95.8% (95% CI = 91.6–98.3), respectively. Conclusions: Although high-resolution ultrasound combined with PDS cannot substitute SLNB, this technique offers earlier diagnosis of lymph node involvement in a small subgroup of patients (with subcapsular location of metastases), and introduces the possibility to exclude those patients from SLN procedure and directly prepare them for complete lymph node dissection (CLND).

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The Use of High-Resolution Ultrasonography for Preoperative Detection of Metastases in Sentinel Lymph Nodes of Patients with Cutaneous Melanoma

Abstract: High resolution B-mode US cannot replace SLNB, especially in the detection of micrometastases, but it remains the most important method to assess the lymph node status for macrometastases presurgically.

Cited by 33 publications

References 28 publications

Contrast-Enhanced Ultrasound Imaging of Sentinel Lymph Nodes After Peritumoral Administration of Sonazoid in a Melanoma Tumor Animal Model

Contrast-Enhanced Ultrasound Imaging of Sentinel Lymph Nodes After Peritumoral Administration of Sonazoid in a Melanoma Tumor Animal Model

Sonography for Locoregional Staging and Follow-up of Cutaneous Melanoma

High-Resolution Ultrasound Combined with Power Doppler Sonography Can Reduce the Number of Sentinel Lymph Node Biopsies in Cutaneous Melanoma

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