Ultrasound-guided Fine Needle Aspiration Cytology prior to Sentinel Lymph Node Biopsy in Melanoma Patients

Voit, Christiane; Kron, Martina; Schäfer, Gregor; Schoengen, A.; Audring, Heike; Lukowsky, Ansgar; Schwürzer-Voit, Markus; Sterry, Wolfram; Winter, H.; Rademaker, Jürgen

doi:10.1245/s10434-006-9046-4

Cited by 110 publications

(79 citation statements)

References 21 publications

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“…An additional tool is preoperative ultrasound with fine-needle aspiration cytology. Ultrasound may be able to diminish the risks associated with tumor blockage by detecting sizable metastases that are not yet palpable (16)(17)(18)(19). Another measure for reducing the chances of false-negative results is intraoperative palpation of the wound to identify unstained and nonradioactive lymph nodes that are suspected of containing metastases because of their consistency but that were not found during physical examination and ultrasound (6,20,21).…”

Section: Discussionmentioning

confidence: 99%

Visualization of Tumor Blockage and Rerouting of Lymphatic Drainage in Penile Cancer Patients by Use of SPECT/CT

Leijte¹,

Ploeg²,

Olmos³

et al. 2009

J Nucl Med

111

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The reliability of sentinel node biopsy is dependent on the accurate visualization and identification of the sentinel node(s). It has been suggested that extensive metastatic involvement of a sentinel node can lead to blocked inflow and rerouting of lymph fluid to a ''neo-sentinel node'' that may not yet contain tumor cells, causing a false-negative result. However, there is little evidence to support this hypothesis. Recently introduced hybrid SPECT/ CT scanners provide both tomographic lymphoscintigraphy and anatomic detail. Such a scanner enabled the present study of the concept of tumor blockage and rerouting of lymphatic drainage in patients with palpable groin metastases. Methods: Seventeen patients with unilateral palpable and cytologically proven metastases in the groin underwent bilateral conventional lymphoscintigraphy and SPECT/CT before sentinel node biopsy of the contralateral groin. The pattern of lymphatic drainage in the 17 palpable groin metastases was evaluated for signs of tumor blockage or rerouting. Results: On the CT images, the palpable node metastases could be identified in all 17 groins. Four of the 17 palpable node metastases (24%) showed uptake of radioactivity on the SPECT/CT images. In 10 groins, rerouting of lymphatic drainage to a neo-sentinel node was seen; one neo-sentinel node was located in the contralateral groin. A complete absence of lymphatic drainage was seen in the remaining 3 groins. Conclusion: The concept of tumor blockage and rerouting was visualized in 76% of the groins with palpable metastases. Precise physical examination and preoperative ultrasound with fine-needle aspiration cytology may identify nodes with considerable tumor invasion at an earlier stage and thereby reduce the incidence of false-negative results.

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Section: Discussionmentioning

confidence: 99%

Visualization of Tumor Blockage and Rerouting of Lymphatic Drainage in Penile Cancer Patients by Use of SPECT/CT

Leijte¹,

Ploeg²,

Olmos³

et al. 2009

J Nucl Med

111

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“…Several series [12][13][14] have shown the superiority of sonographically guided FNAC in comparison with palpation guided FNAC. Particularly, it is known that sonographic guidance reduces the number of false-negative results by indicating the most suspicious lymph node within a given station, by driving the needle toward very small (not palpable) targets, and by showing that the needle tip is actually within the lymph node.…”

Section: Sonographically Guided Interventionmentioning

confidence: 99%

“…The combination with sonographically guided FNAC allows maximization of the overall accuracy. [12][13][14] Nevertheless, sonography of patients with melanoma requires specific experience and training. 15,16 Falsenegative results can be due to inadequate operator training, use of nonupdated or inadequately set equipment, failure to enclose the lymph node in the scanned areas, subtle malignant changes, and micrometastasis.…”

mentioning

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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“…A few radiologists are in favor of staging regional lymph node basins in stage I-II melanoma with high-resolution ultrasonography [24][25][26]. However, the general opinion is that targeted high-resolution ultrasonography is not an effective substitute for SLNB in patients with primary melanoma [27][28][29][30].…”

Section: Reviewmentioning

confidence: 99%