Ultrasound Examination of Sentinel Nodes in the Initial Assessment of Patients With Primary Cutaneous Melanoma

Starritt, Emma C.; Uren, Roger F.; Scolyer, Richard A.; Quinn, Michael J.; Thompson, John F.

doi:10.1007/s10434-004-1163-3

Cited by 93 publications

(44 citation statements)

References 17 publications

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“…The Melanoma Institute Australia, University of Sydney (former name: Sydney Melanoma Unit) has previously reported that ultrasound is able to reliably detect SLN metastases that are greater than 4.5 mm in diameter. This is in accordance with results of a former study of Starrit et al [21] who performed SLN ultrasound after lymphoscintigraphy in 304 patients presenting with primary cutaneous melanomas. Histopathologic examination revealed 33 positive SLNs in 31 patients, and, seven out of this group were suspicious for metastases by ultrasonography.…”

Section: Discussionsupporting

confidence: 82%

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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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Section: Discussionsupporting

confidence: 82%

“…However, the results of the preoperative detection of SLN metastases by high resolution ultrasound are controversial [19,20,21,22,23,24,25,26]. High-resolution ultrasonography without Doppler sonography had been evaluated as diagnostic tool but failed to replace the SLNB, especially as far as the detection of micrometastases is concerned.…”

Section: Introductionmentioning

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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“…When compared to the literature, the sensitivity in our hands (51%) is significantly higher than previously reported rates, which differ from 4% to 39% [24][25][26][27][28][29]. In these relatively small series, Starritt et that high-resolution ultrasound (HRUS) yielded a sensitivity of 12% (2/17) [28].…”

Section: Discussioncontrasting

confidence: 52%

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

Voit

Gooskens

Siegel

et al. 2014

European Journal of Cancer

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Background: Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanoma patients is controversial and subject of this study. Methods: Between 2001 and 2010 over 1000 stage I/II consecutive melanoma patients prospectively underwent US-FNAC prior to SN biopsy. All patients underwent lymphoscintigraphy prior to US-FNAC. The Berlin US morphology criteria: Peripheral perfusion (PP), loss of central echoes (LCE) and balloon shaped (BS) were registered. FNAC was performed in case of presence of any of these factors. SN tumour burden was measured according to the Rotterdam criteria. All patients underwent SN or lymph node dissection (LND) in case of positive FNAC. Findings: Mean/median Breslow thickness was 2.58/1.57 mm. Mean/median follow-up was 56/53 months (1-132). SN positivity rate was 21%. US-FNAC Sensitivity was 71% (US only) and 51% (US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). PP, LCE and BS had sensitivity of 69%, 24% and 24% respectively. Sensitivity of (2014) 50, 2280-2288 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m US-FNAC increased with increasing SN tumour burden. PP was an early sign of metastasis (58% in <0.1 mm metastases). Threshold size of a metastasis for FNAC was 0.3 mm. Five-year survival correlated to US-FNAC status (95% in negative and 59% in positive). Interpretation: Ultrasound guided FNAC (US-FNAC) according to the Berlin morphology criteria could correctly identify at least half of all tumour positive sentinel nodes, prior to the surgical SN procedure. Peripheral perfusion is an early sign of metastasis, which is very sensitive, but with lower positive predictive value (PPV). It is responsible for the sensitivity of the procedure. Balloon shape is a sign of advanced metastases, with lower sensitivity, but high PPV. US-FNAC sensitivity correlated with increasing T-stage, ulceration of the primary and increasing SN tumour burden. US-FNAC status accurately predicts survival.

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“…Both methods, however, are inferior to sentinel lymph node biopsy in sensitivity and specificity. Prior to LND, distant metastases shall be ruled out [108,109,113,314,315].…”

Section: Therapeutic Lymphadenectomymentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

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Ultrasound Examination of Sentinel Nodes in the Initial Assessment of Patients With Primary Cutaneous Melanoma

Cited by 93 publications

References 17 publications

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

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

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

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

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