1
|
SERRA-GARCÍA L, ELIANA-RADONICH J, MARTI-MARTI I, VILANA R, RIPOLL E, SÁNCHEZ M, ALÓS L, CARRERA C, PUIG S, MALVEHY J, PODLIPNIK S. Diagnostic Accuracy of Image-guided Biopsies for Diagnosis of Metastatic Melanoma in a Real-life Setting. Acta Derm Venereol 2022; 102:adv00833. [PMID: 36511331 PMCID: PMC9811304 DOI: 10.2340/actadv.v102.3981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Early detection of melanoma metastasis is essential in order to initiate treatment and improve patient prognosis. The aim of this study was to determine the diagnostic accuracy of different image-guided biopsy techniques in patients with melanoma. A cohort study of patients diagnosed with melanoma who had undergone image-guided biopsies (ultrasound-guided fine-needle aspiration cytology, ultrasound-guided core-needle biopsy, computerized tomography--guided fine-needle aspiration cytology and computerized tomography-guided core-needle biopsy) to detect melanoma metastasis between 2004 and 2021 was conducted. The reference standard was histological confirmation and/or clinical-radiological follow-up. Sensitivity, specificity, positive and negative predictive values were calculated. A total of 600 image--guided biopsies performed on 460 patients were included for analysis. Locoregional lesions represented 459 (76.5%) biopsies, and 141 (23.5%) were distant lesions. Of the included biopsies, 49 (8.2%) were insufficient for diagnosis. Overall, sensitivity and specificity were 92% (95% confidence interval 89-94) and 96% (95% confidence interval 91-99), respectively. Sensitivity sub-analyses revealed lower diagnostic accuracy values in the lung, inguinal lymph nodes, and computerized tomography-guided lesions under 1 cm. Limitations include spontaneous metastasis regression and arbitrary minimum follow-up period. Image-guided biopsies in patients with melanoma have high sensitivity and specificity for detection of regional or distant metastasis. Tissue type, location and tumour burden may influence the diagnostic accuracy of the test.
Collapse
Affiliation(s)
- Laura SERRA-GARCÍA
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona
| | | | - Ignasi MARTI-MARTI
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona
| | - Ramon VILANA
- Department of Radiology, Hospital Clínic Barcelona, University of Barcelona
| | - Enric RIPOLL
- Department of Radiology, Hospital Clínic Barcelona, University of Barcelona
| | - Marcelo SÁNCHEZ
- Department of Radiology, Hospital Clínic Barcelona, University of Barcelona
| | - Llúcia ALÓS
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS),Department of Pathology, Hospital Clínic Barcelona, University of Barcelona
| | - Cristina CARRERA
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona,Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS),Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana PUIG
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona,Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS),Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Josep MALVEHY
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona,Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS),Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Sebastian PODLIPNIK
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona,Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| |
Collapse
|
2
|
Salim DN, Obinah MPB, Ternov NK, McCullagh MJD, Larsen MS, Hendel HW, Hölmich LR, Chakera AH. Fine needle and core needle ultrasound guided biopsies for assessing suspected melanoma metastasis in lymph nodes and subcutaneous tissue. J Surg Oncol 2022; 126:1058-1066. [DOI: 10.1002/jso.26998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/20/2022]
Affiliation(s)
- David N. Salim
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Magnus P. B. Obinah
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Niels K. Ternov
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Mark J. D. McCullagh
- Department of Radiology Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Mathilde S. Larsen
- Department of Pathology Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Helle W. Hendel
- Department of Clinical Physiology, Nuclear Medicine and PET Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Lisbet R. Hölmich
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Annette H. Chakera
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
3
|
Ronchi A, Montella M, Zito Marino F, Argenziano G, Moscarella E, Brancaccio G, Ferraro G, Nicoletti GF, Troiani T, Franco R, Cozzolino I. Cytologic diagnosis of metastatic melanoma by FNA: A practical review. Cancer Cytopathol 2022; 130:18-29. [PMID: 34310059 PMCID: PMC9292535 DOI: 10.1002/cncy.22488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 01/07/2023]
Abstract
Malignant melanoma (MM) is a highly aggressive neoplasm with a growing worldwide incidence. It is not uncommon that the disease is already metastatic at the time of the first diagnosis. Regional lymph nodes and skin are the first and most common metastatic sites, followed by distant visceral sites (lungs, liver, and central nervous system) and bone. In this clinical setting, fine-needle aspiration (FNA) often represents the first diagnostic approach. FNA is a useful tool to obtain a rapid and accurate diagnosis, in conjunction with ancillary techniques and molecular analysis, as recommended by recent guidelines. The aim of this review was to describe the cytomorphology, immunocytochemical tools, and molecular tools used for the diagnosis of MM metastases on FNA.
Collapse
Affiliation(s)
- Andrea Ronchi
- Pathology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marco Montella
- Pathology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Federica Zito Marino
- Pathology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giuseppe Argenziano
- Dermatology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Elvira Moscarella
- Dermatology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Gabriella Brancaccio
- Dermatology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giuseppe Ferraro
- Plastic Surgery UnitMultidisciplinary Department of Medical, Surgical, and Odontological SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giovanni Francesco Nicoletti
- Plastic Surgery UnitMultidisciplinary Department of Medical, Surgical, and Odontological SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Teresa Troiani
- Oncology Unit, Department of Precision MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Renato Franco
- Pathology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Immacolata Cozzolino
- Pathology UnitDepartment of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| |
Collapse
|
4
|
Yang L, Sun W, Xu Y, Zhang X, Wang S, Wang C, Chen Y. Fine Needle Aspiration Cytology (FNAC) for Chinese Patients With Acral and Cutaneous Melanoma: Accuracy and Safety Analysis From a Single Institution. Front Oncol 2020; 10:1724. [PMID: 33194572 PMCID: PMC7604510 DOI: 10.3389/fonc.2020.01724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the accuracy and safety of fine-needle aspiration cytology (FNAC) in Chinese patients with acral and cutaneous melanoma, and also to evaluate the influencing factors and their impact on prognosis. Data of 128 patients with stage 0-III acral and cutaneous melanoma treated in Fudan University Shanghai Cancer Center from 2009 to 2016 were collected from a prospective database. Further, 128 patients who did not undergo FNAC but had similar parameters were recruited as the matched group. Clinical features, FNAC status, and recurrence or metastasis status of patients were analyzed for overall survival (OS), melanoma-specific survival (MSS), recurrence-free survival (RFS), and metastasis-free survival (MFS). Of the 128 patients with FNAC, 5.5% (7/128) had a negative cytological diagnosis, 12.2% (5/41) had primary lesions, and 2.3% (2/87) had lesions in lymph nodes. Tumor thickness, status of ulceration, and subtype were not associated with accuracy for both primary and lymph node FNAC. With a median follow-up of 40 months in all patients, 55 had melanoma-specific death; the median OS and MSS were 95 months and 104 months, respectively. Patients with FNAC had significantly worse OS. Tumor progression occurred in 130 patients. The survival analysis revealed differences in OS and disease-free survival between the two groups. FNAC impacted patients' RFS and MFS; the difference in survival curves of RFS and MFS was also statistically significant. FNAC on primary or superficial lymphatic lesions was a good diagnostic tool for Chinese patients with acral and cutaneous melanoma, but it adversely impacted prognosis.
Collapse
Affiliation(s)
- Lingge Yang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Xu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xun Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Ultrasound Diagnosis, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chunmeng Wang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yong Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Zhu XH, Zhou JN, Qian YY, Yang K, Wen QL, Zhang QH, Xia L, Ge MH, Sun CX. Diagnostic values of thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis diagnostic values of FNA-Tg. Endocr J 2020; 67:113-123. [PMID: 31723088 DOI: 10.1507/endocrj.ej18-0558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Thyroglobulin measurement in the needle washout after fine-needle aspiration (FNA-Tg) served as an important measurement for suspicious recurrent or metastatic lesions. We conducted a pooled analysis to evaluate the diagnostic accuracy of FNA-Tg and searched electronic databases for original articles in English from 1993 through 2017. Finally, a total of 22 studies containing 2,670 lymph nodes (LNs) that enrolled participants with suspicious neck LNs during thyroid nodule workup or papillary thyroid cancer (PTC) follow-up were included. In our analysis, the overall pooled sensitivity for FNA-Tg was 0.91 (95%CI: 0.87-0.93), specificity was 0.94 (95% CI: 0.91-0.96). Meta regression revealed that the cutoff value and status of serum Tg were sources of heterogeneity for sensitivity, and the cutoff value was source of heterogeneity for specificity. Additionally, the cutoff value and status of serum Tg were sources of heterogeneity in the joint model. Subgroup analysis about cut-off value showed that the choice of 1 ng/mL had highest sensitivity, 40 ng/mL had highest specificity. At last, we arrived at the conclusion that FNA-Tg measurement had high specificity and sensitivity in the early detection of LNs metastases from PTC by our meta-analysis. The technique was simple and could be recommended to apply in any FNA facility, especially when LN were small-sized. Significantly, a better standardization of criteria for FNA-Tg detection and cutoff value was required to provide useful data and to improve management of PTC patients in the future.
Collapse
Affiliation(s)
- Xu-Hang Zhu
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Jing-Nan Zhou
- Department of Equipment, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Yang-Yang Qian
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Ke Yang
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Qing-Liang Wen
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Qi-Hong Zhang
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Liang Xia
- Department of Neurosurgeon, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Ming-Hua Ge
- Department of Head and Neck Surgery, Thyroid Surgery of People's Hospital of Zhejiang Province and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Cai-Xing Sun
- Department of Neurosurgeon, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| |
Collapse
|
6
|
Upadhyay Baskota S, Monaco SE, Xing J, Pantanowitz L. Peritheliomatous pattern: A diagnostic clue for diagnosing metastatic melanoma in cytology. Cancer Cytopathol 2020; 128:260-268. [PMID: 31985897 DOI: 10.1002/cncy.22241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND A peritheliomatous pattern (PP) in tumors is characterized by a sheath of viable tumor cells closely surrounding a central blood vessel. In the authors' cytology practice, such a PP has been recognized in several metastatic melanoma specimens. The aim of this study was to evaluate the frequency of a PP in cytology samples of melanoma in comparison with other tumors. METHODS Eighty archival fine-needle aspiration (FNA) cases of metastatic melanoma were compared with 65 control cases (35 poorly differentiated/metastatic carcinomas, 15 lymphomas, and 15 recurrent/metastatic/high-grade sarcomas). Cytologic findings were correlated with corresponding histologic specimens, which were available for 44 cases (55%) in the melanoma group and for 23 cases (35.38%) in the control group. All slides were examined for a PP and were semiquantitatively graded for comparison. RESULTS A PP was present in 51.3% of the cytologic preparations (n = 41) among the melanoma group cases, whereas in the control group, a PP was present in only 3.1% of the cases (n = 2). A PP was present in 65.9% of melanomas with available histologic sections (n = 29) and in 8.7% of tissue samples from the control group (n = 2). A PP was seen more often in cell blocks than direct smear preparations (51.3% vs 40.0%) from patients with melanoma. CONCLUSIONS The presence of a characteristic PP can be helpful in diagnosing melanoma in FNA samples because it was present in almost half of the metastatic melanoma cases in this study and was rarely present in other tumor types. A PP is easier to recognize and more often presents in cell blocks than aspirate smears. Ancillary studies such as immunohistochemistry are helpful for excluding other entities that may exhibit a PP.
Collapse
Affiliation(s)
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
7
|
Riquelme-Mc Loughlin C, Podlipnik S, Bosch-Amate X, Riera-Monroig J, Barreiro A, Espinosa N, Moreno-Ramírez D, Giavedoni P, Vilana R, Sánchez M, Vidal-Sicart S, Carrera C, Malvehy J, Puig S. Diagnostic accuracy of imaging studies for initial staging of T2b to T4b melanoma patients: A cross-sectional study. J Am Acad Dermatol 2019; 81:1330-1338. [DOI: 10.1016/j.jaad.2019.05.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
|
8
|
Kapatia G, Gupta P, Rohilla M, Gupta N, Srinivasan R, Rajwanshi A, Dey P. The spectrum of malignant melanoma on cytology: A tertiary care center study. Diagn Cytopathol 2019; 47:1018-1023. [DOI: 10.1002/dc.24265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Gargi Kapatia
- Department of Cytology and Gynecologic PathologyPost Graduate Institute of Medical Education and Research Chandigarh India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic PathologyPost Graduate Institute of Medical Education and Research Chandigarh India
| | - Manish Rohilla
- Department of Cytology and Gynecologic PathologyPost Graduate Institute of Medical Education and Research Chandigarh India
| | - Nalini Gupta
- Department of CytologyPost Graduate Institute of Medical Education and Research. Chandigarh India
| | - Radhika Srinivasan
- Department of CytologyPost Graduate Institute of Medical Education and Research. Chandigarh India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic PathologyPost Graduate Institute of Medical Education and Research Chandigarh India
| | - Pranab Dey
- Department of Cytology and Gynecologic PathologyPost Graduate Institute of Medical Education and Research Chandigarh India
| |
Collapse
|
9
|
Dinnes J, Ferrante di Ruffano L, Takwoingi Y, Cheung ST, Nathan P, Matin RN, Chuchu N, Chan SA, Durack A, Bayliss SE, Gulati A, Patel L, Davenport C, Godfrey K, Subesinghe M, Traill Z, Deeks JJ, Williams HC. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database Syst Rev 2019; 7:CD012806. [PMID: 31260100 PMCID: PMC6601698 DOI: 10.1002/14651858.cd012806.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Melanoma is one of the most aggressive forms of skin cancer, with the potential to metastasise to other parts of the body via the lymphatic system and the bloodstream. Melanoma accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Various imaging tests can be used with the aim of detecting metastatic spread of disease following a primary diagnosis of melanoma (primary staging) or on clinical suspicion of disease recurrence (re-staging). Accurate staging is crucial to ensuring that patients are directed to the most appropriate and effective treatment at different points on the clinical pathway. Establishing the comparative accuracy of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT imaging for detection of nodal or distant metastases, or both, is critical to understanding if, how, and where on the pathway these tests might be used. OBJECTIVES Primary objectivesWe estimated accuracy separately according to the point in the clinical pathway at which imaging tests were used. Our objectives were:• to determine the diagnostic accuracy of ultrasound or PET-CT for detection of nodal metastases before sentinel lymph node biopsy in adults with confirmed cutaneous invasive melanoma; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging in adults with cutaneous invasive melanoma:○ for detection of any metastasis in adults with a primary diagnosis of melanoma (i.e. primary staging at presentation); and○ for detection of any metastasis in adults undergoing staging of recurrence of melanoma (i.e. re-staging prompted by findings on routine follow-up).We undertook separate analyses according to whether accuracy data were reported per patient or per lesion.Secondary objectivesWe sought to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging (detection of any metastasis) in mixed or not clearly described populations of adults with cutaneous invasive melanoma.For study participants undergoing primary staging or re-staging (for possible recurrence), and for mixed or unclear populations, our objectives were:• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of nodal metastases;• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases according to metastatic site. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included studies of any design that evaluated ultrasound (with or without the use of fine needle aspiration cytology (FNAC)), CT, MRI, or PET-CT for staging of cutaneous melanoma in adults, compared with a reference standard of histological confirmation or imaging with clinical follow-up of at least three months' duration. We excluded studies reporting multiple applications of the same test in more than 10% of study participants. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2)). We estimated accuracy using the bivariate hierarchical method to produce summary sensitivities and specificities with 95% confidence and prediction regions. We undertook analysis of studies allowing direct and indirect comparison between tests. We examined heterogeneity between studies by visually inspecting the forest plots of sensitivity and specificity and summary receiver operating characteristic (ROC) plots. Numbers of identified studies were insufficient to allow formal investigation of potential sources of heterogeneity. MAIN RESULTS We included a total of 39 publications reporting on 5204 study participants; 34 studies reporting data per patient included 4980 study participants with 1265 cases of metastatic disease, and seven studies reporting data per lesion included 417 study participants with 1846 potentially metastatic lesions, 1061 of which were confirmed metastases. The risk of bias was low or unclear for all domains apart from participant flow. Concerns regarding applicability of the evidence were high or unclear for almost all domains. Participant selection from mixed or not clearly defined populations and poorly described application and interpretation of index tests were particularly problematic.The accuracy of imaging for detection of regional nodal metastases before sentinel lymph node biopsy (SLNB) was evaluated in 18 studies. In 11 studies (2614 participants; 542 cases), the summary sensitivity of ultrasound alone was 35.4% (95% confidence interval (CI) 17.0% to 59.4%) and specificity was 93.9% (95% CI 86.1% to 97.5%). Combining pre-SLNB ultrasound with FNAC revealed summary sensitivity of 18.0% (95% CI 3.58% to 56.5%) and specificity of 99.8% (95% CI 99.1% to 99.9%) (1164 participants; 259 cases). Four studies demonstrated lower sensitivity (10.2%, 95% CI 4.31% to 22.3%) and specificity (96.5%,95% CI 87.1% to 99.1%) for PET-CT before SLNB (170 participants, 49 cases). When these data are translated to a hypothetical cohort of 1000 people eligible for SLNB, 237 of whom have nodal metastases (median prevalence), the combination of ultrasound with FNAC potentially allows 43 people with nodal metastases to be triaged directly to adjuvant therapy rather than having SLNB first, at a cost of two people with false positive results (who are incorrectly managed). Those with a false negative ultrasound will be identified on subsequent SLNB.Limited test accuracy data were available for whole body imaging via PET-CT for primary staging or re-staging for disease recurrence, and none evaluated MRI. Twenty-four studies evaluated whole body imaging. Six of these studies explored primary staging following a confirmed diagnosis of melanoma (492 participants), three evaluated re-staging of disease following some clinical indication of recurrence (589 participants), and 15 included mixed or not clearly described population groups comprising participants at a number of different points on the clinical pathway and at varying stages of disease (1265 participants). Results for whole body imaging could not be translated to a hypothetical cohort of people due to paucity of data.Most of the studies (6/9) of primary disease or re-staging of disease considered PET-CT, two in comparison to CT alone, and three studies examined the use of ultrasound. No eligible evaluations of MRI in these groups were identified. All studies used histological reference standards combined with follow-up, and two included FNAC for some participants. Observed accuracy for detection of any metastases for PET-CT was higher for re-staging of disease (summary sensitivity from two studies: 92.6%, 95% CI 85.3% to 96.4%; specificity: 89.7%, 95% CI 78.8% to 95.3%; 153 participants; 95 cases) compared to primary staging (sensitivities from individual studies ranged from 30% to 47% and specificities from 73% to 88%), and was more sensitive than CT alone in both population groups, but participant numbers were very small.No conclusions can be drawn regarding routine imaging of the brain via MRI or CT. AUTHORS' CONCLUSIONS Review authors found a disappointing lack of evidence on the accuracy of imaging in people with a diagnosis of melanoma at different points on the clinical pathway. Studies were small and often reported data according to the number of lesions rather than the number of study participants. Imaging with ultrasound combined with FNAC before SLNB may identify around one-fifth of those with nodal disease, but confidence intervals are wide and further work is needed to establish cost-effectiveness. Much of the evidence for whole body imaging for primary staging or re-staging of disease is focused on PET-CT, and comparative data with CT or MRI are lacking. Future studies should go beyond diagnostic accuracy and consider the effects of different imaging tests on disease management. The increasing availability of adjuvant therapies for people with melanoma at high risk of disease spread at presentation will have a considerable impact on imaging services, yet evidence for the relative diagnostic accuracy of available tests is limited.
Collapse
Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | | | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Seau Tak Cheung
- Dudley Hospitals Foundation Trust, Corbett HospitalDepartment of DermatologyWicarage RoadStourbridgeUKDY8 4JB
| | - Paul Nathan
- Mount Vernon HospitalMount Vernon Cancer CentreRickmansworth RoadNorthwoodUKHA6 2RN
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Sue Ann Chan
- City HospitalBirmingham Skin CentreDudley RdBirminghamUKB18 7QH
| | - Alana Durack
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustDermatologyHills RoadCambridgeUKCB2 0QQ
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Abha Gulati
- Barts Health NHS TrustDepartment of DermatologyWhitechapelLondonUKE11BB
| | - Lopa Patel
- Royal Stoke HospitalPlastic SurgeryStoke‐on‐TrentStaffordshireUKST4 6QG
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Manil Subesinghe
- King's College LondonCancer Imaging, School of Biomedical Engineering & Imaging SciencesLondonUK
| | - Zoe Traill
- Oxford University Hospitals NHS TrustChurchill Hospital Radiology DepartmentOxfordUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
| | | | | |
Collapse
|
10
|
Coincidence of Malignant Melanoma and an Incidently Discovered Parotid Mass Presenting a Diagnostic Challenge. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1897. [PMID: 30324074 PMCID: PMC6181513 DOI: 10.1097/gox.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/15/2022]
Abstract
Parotid masses coincided with skin tumors in head and neck region may represent a serious diagnostic challenge. Conventional imaging modalities such as computed tomography, magnetic resonance imaging may help to determine nature of the masses. Positron emission tomography - computed tomography imaging is reported to be useful for the detection of malignancy in the parotid gland. But in some situations all of them become insufficient. We present a case of cheek malignant melanoma with an incidentally discovered parotid mass during the investigation. We describe the problems experienced in the course of differential diagnosis and decision making in terms of surgical management. As a result, the most reliable diagnosis of suspicious parotid lesions accompanying head and neck melanomas comes from frozen section analyses. The other diagnostic tools are not reliable enough to allow a safe surgical plan in terms of regional treatment; however, the significance of positron emission tomography - computed tomography in distant metastasis investigation should always be kept in mind.
Collapse
|
11
|
Narayanamurthy V, Padmapriya P, Noorasafrin A, Pooja B, Hema K, Firus Khan AY, Nithyakalyani K, Samsuri F. Skin cancer detection using non-invasive techniques. RSC Adv 2018; 8:28095-28130. [PMID: 35542700 PMCID: PMC9084287 DOI: 10.1039/c8ra04164d] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/22/2018] [Indexed: 12/22/2022] Open
Abstract
Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.
Collapse
Affiliation(s)
- Vigneswaran Narayanamurthy
- InnoFuTech No: 42/12, 7th Street, Vallalar Nagar, Pattabiram Chennai Tamil Nadu 600072 India
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
| | - P Padmapriya
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - A Noorasafrin
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - B Pooja
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - K Hema
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - Al'aina Yuhainis Firus Khan
- Department of Biomedical Science, Faculty of Allied Health Sciences, International Islamic University Malaysia 25200 Kuantan Pahang Malaysia
| | - K Nithyakalyani
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - Fahmi Samsuri
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
| |
Collapse
|
12
|
Eiger D, de Oliveira DA, de Oliveira RL, Sousa MC, Brandão MDC, de Oliveira Filho ,RS. Complete lymphadenectomy following positive sentinel lymph node biopsy in cutaneous melanoma: a critical review. An Bras Dermatol 2018; 93:553-558. [PMID: 30066763 PMCID: PMC6063107 DOI: 10.1590/abd1806-4841.20187312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/19/2018] [Indexed: 01/19/2023] Open
Abstract
Cutaneous melanoma is the solid neoplasia with the highest growing incidence among all tumors. It spreads predictably to the lymphatic vessels and sentinel lymph node, and when the latter is affected the prognosis worsens dramatically. Sentinel lymph node biopsy is considered when thickness of the primary tumor exceeds 1mm and/or when there are adverse features in thinner melanomas. When there is nodal metastasis, current evidence in the literature recommends complete lymphadenectomy, although this procedure has its intrinsic risks (i.e., lymphedema and cellulitis), and there are no published clinical trials proving additional overall survival benefits. The current in-depth literature review thus aims to identify patients that will benefit most from the procedure, including those with the highest likelihood of presenting additional affected lymph nodes in the same nodal basin. The authors also discuss techniques for identification of the sentinel lymph node, false-negative rates, and predictive models for lymph node involvement. In conclusion, complete elective lymphadenectomy should always be discussed on a case-by-case basis when metastases are detected in the sentinel lymph node.
Collapse
Affiliation(s)
- Daniel Eiger
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Centro Paulista de Oncologia, São Paulo (SP), Brazil
| | - Daniel Arcuschin de Oliveira
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Student Training Program in General Surgery by Colégio
Brasileiro de Cirurgiões, Hospital Stella Maris, Guarulhos (SP), Brazil
| | | | - Murilo Costa Sousa
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Medical Student, Faculdade Santa Marcelina, São Paulo (SP),
Brazil
| | - Mireille Darc Cavalcante Brandão
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Oncogynecology Division, Hospital Santa Marcelina, São Paulo
(SP), Brazil
- Oncology Outpatient Clinic, Hospital Santa Paula, São Paulo
(SP), Brazil
- Department of Oncology, Oncodermatology Division, Hospital 9 de
Julho, São Paulo (SP), Brazil
| | - ,Renato Santos de Oliveira Filho
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Centro de Oncologia e Hematologia Família Dayan Daycoval,
Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| |
Collapse
|
13
|
|
14
|
Schäfer-Hesterberg G, Schoengen A, Sterry W, Voit C. Use of ultrasound to early identify, diagnose and localize metastases in melanoma patients. Expert Rev Anticancer Ther 2014; 7:1707-16. [DOI: 10.1586/14737140.7.12.1707] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Hall BJ, Schmidt RL, Sharma RR, Layfield LJ. Fine-needle aspiration cytology for the diagnosis of metastatic melanoma: systematic review and meta-analysis. Am J Clin Pathol 2013; 140:635-42. [PMID: 24124141 DOI: 10.1309/ajcpwsddhllw40wi] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To perform a thorough review and meta-analysis of studies that have shown non-image-guided fine-needle aspiration cytology (FNAC) to be highly sensitive and specific for assessing questionable metastatic melanoma to lymph nodes. METHODS MEDLINE and Scopus were searched for potentially relevant articles with a search string including the words "melanoma" and "fine needle." All relevant articles were screened by two authors (B.J.H. and R.L.S.). Full articles were screened for extractable data, and the data was pooled for analysis. RESULTS Of 978 unique studies found, 10 (5,518 cases) met our inclusion criteria. In a pooled analysis of palpation and ultrasound-guided fine-needle aspirations, the area under the receiver operating characteristic curve was 0.99 (95% confidence interval [CI], 0.99-1.00). The summary estimates for the sensitivity and specificity were 0.97 (95% CI, 0.95-0.98) and 0.98 (95% CI, 0.98-1.00), respectively. CONCLUSIONS With a sensitivity and specificity of 0.97 and 0.99, the overall diagnostic accuracy of FNAC for metastatic melanoma is quite high, and with a positive and negative likelihood ratio of 58 and 0.03, FNAC for metastatic melanoma should be the first-line option in a patient with a clinically suspected mass and a history of melanoma.
Collapse
Affiliation(s)
- Brian J. Hall
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Robert L. Schmidt
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Rohit R. Sharma
- Department of Surgery, University of Texas Southwestern Medical School, Dallas
| | - Lester J. Layfield
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| |
Collapse
|
16
|
Özden MG, Maier T, Bek Y, Ruzicka T, Berking C. Cytodiagnosis of erosive melanoma and basal cell carcinoma of the skin using cutaneous tissue smear. Clin Exp Dermatol 2013; 38:251-61. [PMID: 23517355 DOI: 10.1111/ced.12085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cytomorphological assessment of erosive skin tumours offers a rapid and minimally invasive way to obtain a diagnosis. However, the studies so far conducted on this method have been relatively small. AIM To conduct a large retrospective study on cytomorphological assessment of erosive skin tumours. METHODS In this study, 86 cytological smears prepared from erosive cutaneous tumours clinically suspicious for melanoma were examined to test the diagnostic accuracy and practicability of cytomorphological evaluation of such tumours, and to compare the assessments of two investigators with different experience levels. In a subgroup of tumours, cytological assessment was compared with dermoscopic evaluation. RESULTS There was agreement in the cytological and histopathological results for 68 of 86 cases (79%) assessed by the experienced investigator and in 64 of 86 cases (74%) assessed by the inexperienced investigator. The diagnosis was confirmed cytologically in 39 and 34 of 42 melanomas, and in 28 and 27 of 35 basal cell carcinomas, respectively. The sensitivity of the cytodiagnosis was not significantly different between the two investigators. The dermoscopic evaluation showed good agreement with the cytological results for melanoma (82.4%), although use of dermoscopy was only possible for 49.9% of the lesions because of difficulties with the samples. CONCLUSIONS Cytological assessment of erosive melanoma and BCC lesions is a useful tool for gaining additional information on clinically uncertain skin tumours, and shows good agreement between different investigators.
Collapse
Affiliation(s)
- M G Özden
- Department of Dermatology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | | | | | | | | |
Collapse
|
17
|
Kumar S, Singh S, Sen R, Gupta S, Chhabbra S, Sangwan M, Lamba S. Profile of Liver Fine Needle Aspiration in Tertiary Care Hospital. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
18
|
Pánczél G, Liszkay G, Borbola K, Balatoni T, Hunyadi J. [The importance of fine needle aspiration cytology in the management of recurrent and metastatic melanoma]. Orv Hetil 2012; 153:1419-23. [PMID: 22951409 DOI: 10.1556/oh.2012.29434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Fine needle aspiration cytology is a widely accepted, reliable diagnostic modality for the early detection of metastases. OBJECTIVE Quality assurance analysis of fine needle aspiration cytology in melanoma patients. METHOD A total of 194 biopsies performed in 142 melanoma patients were analyzed retrospectively. RESULTS 138 (71.13%) cutaneous or subcutaneous nodules and 56 (28.87%) palpable lymph nodes were studied. 87 (44.85%) true positive, 92 (47.42%) true negative, 3 (1.55%) false positive and 12 (6.19%) false negative cytology results were found. High sensitivity (87.89%), specificity (96.84%) and diagnostic accuracy (93.72%) were confirmed. DISCUSSION The quality assurance of fine needle aspiration biopsy in these patients with recurrent and metastatic melanoma meets the international requirements.
Collapse
Affiliation(s)
- Gitta Pánczél
- Országos Onkológiai Intézet Budapest Ráth György u. 7-9. 1122.
| | | | | | | | | |
Collapse
|
19
|
Chai CY, Zager JS, Szabunio MM, Marzban SS, Chau A, Rossi RM, Sondak VK. Preoperative ultrasound is not useful for identifying nodal metastasis in melanoma patients undergoing sentinel node biopsy: preoperative ultrasound in clinically node-negative melanoma. Ann Surg Oncol 2011; 19:1100-6. [PMID: 22193886 DOI: 10.1245/s10434-011-2172-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is widely used in melanoma. Identifying nodal involvement preoperatively by high-resolution ultrasound may offer less invasive staging. This study assessed feasibility and staging results of clinically targeted ultrasound (before lymphoscintigraphy) compared to SLNB. METHODS From 2005 to 2009, a total of 325 patients with melanoma underwent ultrasound before SLNB. We reviewed demographics and histopathologic characteristics, then compared ultrasound and SLNB results. Sensitivity, specificity, and positive and negative predictive value were determined. RESULTS A total of 325 patients were included, 58% men and 42% women with a median age of 58 (range 18-86) years. A total of 471 basins were examined with ultrasound. Only six patients (1.8%) avoided SLNB by undergoing ultrasound-guided fine-needle aspiration of involved nodes, then therapeutic lymphadenectomy. Sixty-five patients (20.4%) had 69 SLNB positive nodal basins; 17 nodal basins from 15 patients with positive ultrasounds were considered truly positive. Forty-five SLNB positive basins had negative ultrasounds (falsely negative). Seven node-positive basins did not undergo ultrasound because of unpredicted drainage. A total of 253 patients with negative SLNBs had negative ultrasounds in 240 nodal basins (truly negative) but falsely positive ultrasounds occurred in 40 basins. Overall, sensitivity of ultrasound was 33.8%, specificity 85.7%, positive predictive value 36.5%, and negative predictive value 84.2%. Sensitivity and specificity improved somewhat with increasing Breslow depth. Sensitivity was highest for the neck, but specificity was highest for the groin. CONCLUSIONS Routine preoperative ultrasound in clinically node-negative melanoma is impractical because of its low sensitivity. Selected patients with thick or ulcerated lesions may benefit. Because of variable lymphatic drainage patterns, preoperative ultrasound without lymphoscintigraphic localization will provide incomplete evaluation in many cases.
Collapse
Affiliation(s)
- Christy Y Chai
- Department of Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Voit CA, van Akkooi ACJ, Eggermont AMM, Schäfer-Hesterberg G, Kron M, Ulrich J, Sterry W, Schoengen A, Rademaker J. Fine needle aspiration cytology of palpable and nonpalpable lymph nodes to detect metastatic melanoma. J Natl Cancer Inst 2011; 103:1771-7. [PMID: 21940673 DOI: 10.1093/jnci/djr381] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is usually used to evaluate palpable nodes in patients with melanoma. The goal of our study is to review the sensitivity and specificity of this technique when applied to palpable but also to nonpalpable nodes. METHODS FNAC was performed during 1984-2007 in 1279 patients with suspicious lesions and/or lymph nodes. Indications for biopsy included increased size and/or palpability of nodes or abnormal ultrasound findings such as increased perfusion or focal lesions within the lymph nodes. The sensitivity, specificity, and positive and negative predictive values of FNACs guided by palpation or ultrasound were calculated for all patients and for subgroups of patients with palpable nodes or nonpalpable but sonomorphologically suspicious nodes. RESULTS A total of 2446 FNACs were performed in 1279 melanoma patients, of which 2011 (82.2%) FNACs had clinically or histologically confirmed results. Increased size and/or palpability of nodes was observed in 376 (29.4%) of 1279 patients, and abnormal ultrasound findings occurred for 903 (70.6%), indicating that a biopsy was needed. FNACs guided by palpation had sensitivity, specificity, and positive and negative predictive values similar to that of FNACs guided by ultrasound (sensitivity = 98.4% vs 97.2%, specificity = 100% vs 99.8%, positive predictive value = 100% vs 99.9%, and negative predictive value = 95.2% vs 96.4%, for palpation-guided FNACs vs ultrasound-guided FNACs, respectively). Results did not differ between patients with the palpable nodes and patients with nonpalpable but sonomorphologically suspicious nodes. CONCLUSIONS Ultrasound-guided FNAC of suspicious lymph nodes and lesions in melanoma patients has a high sensitivity and specificity, and FNAC should not be limited to palpable nodes. FNAC of normal-sized nodes and/or lymph nodes with abnormal ultrasound findings can be used to identify early metastatic disease.
Collapse
Affiliation(s)
- Christiane A Voit
- Department of Dermatology, Charité University Medicine, Charitéplatz 1, Berlin 10117, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Catalano O. Critical analysis of the ultrasonographic criteria for diagnosing lymph node metastasis in patients with cutaneous melanoma: a systematic review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:547-560. [PMID: 21460155 DOI: 10.7863/jum.2011.30.4.547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this systematic review of the literature was to evaluate the use of ultrasonography (US) in the assessment of lymph node metastasis in patients with cutaneous melanoma. A multimodal strategy was used, which was mainly based on a PubMed database search. Among the 201 cumulative articles collected (years 1989-2009), 31 were found to match all of the inclusion criteria and to provide a description of the use of US scanning in lymph node melanoma metastasis. Data extracted included the author's name and country, journal and year of publication, prospective or retrospective nature of the study, single-center or multicenter nature of the study, period when US studies were performed, US transducers used, gray scale and color Doppler criteria used for diagnosis, and data on US accuracy. The diagnostic criteria used in the 31 selected articles were critically reviewed, illustrating to the reader the discrepancies and unclear aspects identified. On the basis of this review, the need to establish definitive, clearly defined, and univocal diagnostic criteria to be applied in daily clinical practice as well as to be used in articles to be published is emphasized.
Collapse
Affiliation(s)
- Orlando Catalano
- First Department of Radiology, National Cancer Institute Fondazione G. Pascale, Naples, Italy.
| |
Collapse
|
22
|
Xing Y, Bronstein Y, Ross MI, Askew RL, Lee JE, Gershenwald JE, Royal R, Cormier JN. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst 2010; 103:129-42. [PMID: 21081714 DOI: 10.1093/jnci/djq455] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Meta-analyses were performed to examine the utility of ultrasonography, computed tomography (CT), positron emission tomography (PET), and a combination of both (PET-CT) for the staging and surveillance of melanoma patients. METHOD Patient-level data from 74 studies containing 10,528 patients (between January 1, 1990, and June, 30, 2009) were used to derive characteristics of the diagnostic tests used. Meta-analyses were conducted by use of Bayesian bivariate binomial models to estimate sensitivity and specificity. Diagnostic odds ratios [ie, true-positive results/false-negative results)/(false-positive results/true-negative results)] and their 95% credible intervals (CrIs) and positive predictive values were used as indicators of test performance. RESULTS Among the four imaging methods examined for the staging of regional lymph nodes, ultrasonography had the highest sensitivity (60%, 95% CrI = 33% to 83%), specificity (97%, 95% CrI = 88% to 99%), and diagnostic odds ratio (42, 95% CrI = 8.08 to 249.8). For staging of distant metastases, PET-CT had the highest sensitivity (80%, 95% CrI = 53% to 93%), specificity (87%, 95% CrI = 54% to 97%), and diagnostic odds ratio (25, 95% CrI = 3.58 to 198.7). Similar trends were observed for melanoma surveillance of lymph node involvement, with ultrasonography having the highest sensitivity (96%, 95% CrI = 85% to 99%), specificity (99%, 95% CrI = 95% to 100%), and diagnostic odds ratio (1675, 95% CrI = 226.6 to 15,920). For distant metastases, PET-CT had the highest sensitivity (86%, 95% CrI = 76% to 93%), specificity (91%, 95% CrI = 79% to 97%), and diagnostic odds ratio (67, 95% CrI = 20.42 to 229.7). Positive predictive values were likewise highest for ultrasonography in lymph node staging and for PET-CT in detecting distant metastases. CONCLUSION Among the compared modalities, ultrasonography was superior for detecting lymph node metastases, and PET-CT was superior for the detection of distant metastases in both the staging and surveillance of melanoma patients.
Collapse
Affiliation(s)
- Yan Xing
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Synchronous and metachronous malignancies in patients with melanoma: a clinicopathologic study highlighting the role of fine-needle biopsy cytology and potential diagnostic pitfalls. Melanoma Res 2010; 20:203-11. [DOI: 10.1097/cmr.0b013e328335058b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
24
|
Catalano O, Setola SV, Vallone P, Raso MM, D'Errico AG. Sonography for locoregional staging and follow-up of cutaneous melanoma: how we do it. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:791-802. [PMID: 20427792 DOI: 10.7863/jum.2010.29.5.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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.
Collapse
Affiliation(s)
- Orlando Catalano
- First Department of Radiology,National Cancer Institute Fondazione G. Pascale, Naples, Italy.
| | | | | | | | | |
Collapse
|
25
|
|
26
|
Voit C, Van Akkooi ACJ, Schäfer-Hesterberg G, Schoengen A, Kowalczyk K, Roewert JC, Sterry W, Eggermont AMM. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol 2010; 28:847-52. [PMID: 20065175 DOI: 10.1200/jco.2009.25.7428] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We have shown that ultrasound (US) -guided fine needle aspiration cytology (FNAC) can accurately identify the sentinel node (SN). Moreover, US-guided FNAC before the surgical SN procedure could identify up to 65% of all SN metastases. Herein we analyzed in detail the different US morphologic patterns of SN metastases. PATIENTS AND METHODS From July 2001 to December 2007, a total of 650 patients with melanoma scheduled for sentinel lymph node dissection were examined. We present the first 400 with sufficient follow-up (mean 40, median 39 months). Several morphologic characteristics were scored. In case of suspicious/clearly malignant US patterns a FNAC was performed. The final histology was considered the gold standard. Results Median Breslow was 1.8 mm. The sensitivity and positive predictive value of the most important factors were: peripheral perfusion (PP) present (77% and 52%, respectively), loss of central echoes (LCE; 60% and 65% respectively), and balloon shape (BS; 30% and 96% respectively). Together these factors have a sensitivity of 82% and PPV of 52% (P < .001). PP identified more patients with lower volume disease. PP and combined BS and LCE were independent prognostic factors for survival (hazard ratio, 2.19; P < .015; and hazard ratio, 5.50; P < .001, respectively). CONCLUSION Preoperative US and FNAC can identify 65% of SN metastases and thus reduce the need for surgical SN procedures. Peripheral perfusion is an early sign of involvement and of crucial importance to achieve a high identification rate. Balloon shape and loss of central echoes are late signs of metastases. We recommend US evaluation to identify those patients, who can directly proceed to a complete lymph node dissection after a positive US-guided FNAC of the SN.
Collapse
Affiliation(s)
- Christiane Voit
- Department of Dermatology, Charité, University Medicine Berlin, Berlin, 10117, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, Thompson JF. Targeted High-Resolution Ultrasound Is Not an Effective Substitute for Sentinel Lymph Node Biopsy in Patients With Primary Cutaneous Melanoma. J Clin Oncol 2009; 27:5614-9. [DOI: 10.1200/jco.2008.21.4882] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To reassess traditional ultrasound descriptors of sentinel lymph node (SLN) metastases, to determine the minimum cross-sectional area (CSA) of an SLN metastasis detectable by ultrasound (US), and to establish whether targeted, high-resolution US of SLNs identified by lymphoscintigraphy before initial melanoma surgery can be used as a substitute for excisional SLN biopsy. Methods US was performed on SLNs identified in 871 lymph node fields in 716 patients. SLN biopsy was performed within 24 hours of lymphoscintigraphy and US examination. The CSA of each SLN metastatic deposit was determined sonographically and histologically. Results The sensitivity of targeted US in the detection of positive SLNs was 24.3% (95% CI, 19.5% to 28.7%), and the specificity was 96.8% (95% CI, 95.9% to 97.7%). The sensitivity was highest for neck SLNs (45.8%) and improved with greater Breslow thickness. The median histologic CSA of the SLN metastatic deposits was 0.39 mm2 (12.75 mm2 for US true-positive results and 0.22 mm2 for US false-negative results). True-positive, US-detected SLNs had significantly greater CSAs (t test P < .001) than undetected SLN metastases and were more likely to be spherical in cross-section. More than two sonographic descriptors of SLN metastases or rounding of the node alone were factors highly suggestive of a melanoma deposit. Conclusion US is not an appropriate substitute for SLN biopsy, but it is of value in preoperative SLN assessment and postoperative monitoring.
Collapse
Affiliation(s)
- Amira Sanki
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Roger F. Uren
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Marc Moncrieff
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kayla L. Tran
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard A. Scolyer
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Hui-Yi Lin
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John F. Thompson
- From the Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals; Department of Anatomical Pathology, Royal Prince Alfred Hospital; Disciplines of Surgery and of Medicine, University of Sydney; and Nuclear Medicine and Diagnostic Ultrasound, Sydney, New South Wales, Australia; and Biostatistics Department, Moffitt Cancer Center and Research Institute, Tampa, FL
| |
Collapse
|
28
|
Voit CA, Schäfer-Hesterberg G, Kron M, van Akkooi AC, Rademaker J, Lukowsky A, Schoengen A, Schwürzer-Voit M, Sterry W, Krause M, Röwert-Huber J, Eggermont AM. Impact of Molecular Staging Methods in Primary Melanoma: Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) of Ultrasound-Guided Aspirate of the Sentinel Node Does Not Improve Diagnostic Accuracy, But RT-PCR of Peripheral Blood Does Predict Survival. J Clin Oncol 2008; 26:5742-7. [DOI: 10.1200/jco.2007.13.7653] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeThis study analyzes (1) the value of tyrosinase reverse-transcriptase polymerase chain reaction (RT-PCR) of aspirates obtained by ultrasound-guided fine-needle aspiration cytology (US-FNAC) of sentinel nodes (SNs) in patients with melanoma before sentinel lymph node biopsy (SLNB) and (2) the value of RT-PCR of blood samples of all SLNB patients.Patients and MethodsBetween 2001 and 2003, 127 patients with melanoma (median Breslow depth, 2.1 mm) underwent SLNB. FNAC was performed in all SNs of all patients pre- and post-SLNB. The aspirates were partly shock-frozen for RT-PCR and were partly used for standard cytology. Peripheral blood was collected at the time of SLNB and at every outpatient visit thereafter.ResultsThirty-four (23%) of 120 SNs were positive for melanoma. SN involvement was predicted by US-FNAC with a sensitivity of 82% and a specificity of 72%. Additional tyrosinase RT-PCR revealed the same sensitivity of 82% and a specificity of 72%. At a median follow-up time of 40 months from first blood sample, peripheral-blood RT-PCR was a significant independent predictor of disease-free survival (DFS) and overall survival (OS; P < .001).ConclusionUS-FNAC is highly accurate and eliminates the need for SLNB in 16% of all SLNB patients. RT-PCR of the aspirate or excised SN does not improve sensitivity or specificity. RT-PCR of blood samples predicts DFS and OS.
Collapse
Affiliation(s)
- Christiane A. Voit
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gregor Schäfer-Hesterberg
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Martina Kron
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alexander C.J. van Akkooi
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Juergen Rademaker
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ansgar Lukowsky
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alfred Schoengen
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Markus Schwürzer-Voit
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Wolfram Sterry
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Markus Krause
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joachim Röwert-Huber
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alexander M.M. Eggermont
- From the Department of Dermatology of the Charité, Humboldt University, Berlin; Departments of Biometry and Medical Documentation and Medical Oncology, University of Ulm, Armed Forces Hospital, Ulm, Germany; Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
29
|
Allan CP, Hayes AJ, Thomas JM. ILIOINGUINAL LYMPH NODE DISSECTION FOR PALPABLE METASTATIC MELANOMA TO THE GROIN. ANZ J Surg 2008; 78:982-6. [DOI: 10.1111/j.1445-2197.2008.04716.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
de Wilt JH, van Akkooi AC, Verhoef C, Eggermont AM. Detection of melanoma micrometastases in sentinel nodes – The cons. Surg Oncol 2008; 17:175-81. [DOI: 10.1016/j.suronc.2008.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
|
32
|
Doubrovsky A, Scolyer RA, Murali R, McKenzie PR, Watson GF, Lee CS, McLeod DJ, McCarthy WH, Uren RF, Stretch JR, Saw RP, Thompson JF. Diagnostic accuracy of fine needle biopsy for metastatic melanoma and its implications for patient management. Ann Surg Oncol 2008; 15:323-32. [PMID: 17990041 PMCID: PMC2190340 DOI: 10.1245/s10434-006-9341-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 11/15/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated. METHODS A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up. RESULTS FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results. CONCLUSIONS FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma.
Collapse
Affiliation(s)
- Anna Doubrovsky
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
| | - Richard A. Scolyer
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
- Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| | - Rajmohan Murali
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
- Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| | - Paul R. McKenzie
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Geoffrey F. Watson
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - C. Soon Lee
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
- Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
| | - Duncan J. McLeod
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - William H. McCarthy
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| | - Roger F. Uren
- Nuclear Medicine and Diagnostic Ultrasound and Discipline of Medicine, The University of Sydney, Sydney, NSW Australia
| | - Jonathan R. Stretch
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| | - Robyn P. Saw
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| | - John F. Thompson
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
- Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW Australia
- Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia
| |
Collapse
|
33
|
Murali R, Thompson JF, Scolyer RA. Fine-needle biopsy as a diagnostic technique for metastatic melanoma. ACTA ACUST UNITED AC 2008; 2:1-10. [PMID: 23485113 DOI: 10.1517/17530059.2.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fine-needle biopsy (FNB) is a rapid, minimally invasive technique, widely used for the investigation and diagnosis of lesions in a variety of body sites. It is a procedure with high diagnostic accuracy for metastatic melanoma, with a sensitivity of 92.1% and a specificity of 99.2% in a recent large study. Although at present FNB has virtually no role in the initial diagnosis of pigmented primary cutaneous tumors, recent evidence suggests that it should be the first-line diagnostic modality for confirmation of clinically and/or radiologically suspected metastases in melanoma patients. As the specimen procured by FNB can be examined within minutes of performing the procedure, an on-demand FNB service with rapid communication of results to the patient's treating clinician enables a more efficient and cost effective approach to the multidisciplinary management of melanoma patients. In the future, it is likely that molecular analysis of very small amounts of tumor tissue obtained by FNB will provide an accurate estimate of prognosis and will facilitate selection of patients who may benefit from targeted molecular therapies.
Collapse
Affiliation(s)
- Rajmohan Murali
- Royal Prince Alfred Hospital, Department of Anatomical Pathology, Camperdown, NSW, 2050, Australia +61 2 9515 7011 ; +61 2 9515 8405 ;
| | | | | |
Collapse
|
34
|
Abstract
Ultrasonography is an essential tool for most medical specialties; training in its use is required for dermatology residency programs in Germany. Ultrasonography is a versatile, painless, low-risk, non-invasive procedure which can be done anywhere and easily repeated; it provides real-time visual information about benign and malignant processes in the skin and subcutis. High frequency sonography with 20 MHz scanners is well-established for measuring the thickness of the skin or its tumors and assessing inflammatory skin disorders. Mid-frequency sonography with 7.5-15 MHz sounds is widely used in dermatologic oncology, both for pre-operative staging and follow-up of melanoma patients. The interpretation of sonographic images such as borders of lesions, echogenicity, artifacts and vascular patterns with duplex color sonography requires structured education and intensive training. The wide variety of diagnostic information provided by sonography underlines its essential position in certified skin cancer centers.
Collapse
Affiliation(s)
- Dorothee Dill-Müller
- Department of Dermatology, Venereology and Allergy, University Clinic of the Saarland, Homburg/Saar, Germany.
| | | |
Collapse
|
35
|
Voit C, Kron M, Schäfer G, Schoengen A, Audring H, Lukowsky A, Schwürzer-Voit M, Sterry W, Winter H, Rademaker J. Ultrasound-guided fine needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol 2007; 13:1682-9. [PMID: 17063307 DOI: 10.1245/s10434-006-9046-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) allows early detection of metastases, thereby enabling early treatment in melanoma patients likely to benefit from adjuvant therapies. This prospective study analyzes the possible benefits of additional ultrasound (US) and fine needle aspiration cytology (FNAC) of sentinel nodes (SN) prior to SLNB. METHOD Over a 2-year period 127 melanoma patients with 151 SN were scheduled for SLNB. All SN were initially identified with lymphoscintigraphy, then identified and evaluated by US and the cells aspirated for cytology (FNAC). US findings and FNAC results were compared to surgical findings. RESULTS Of 127 patients, 114 had one SN each, 12 had two, and one had three. In vivo US achieved a sensitivity of 79% (95% CI: 62-91%) and a specificity of 72% (95% CI: 62-81%). FNAC showed a sensitivity of 59% (95% CI: 41-76%) and a specificity of 100% (95% CI: 95-100%). The combination of these two in vivo methods achieved an overall sensitivity of 82% (95% CI: 65-93%) and an overall specificity of 72% [95% CI: 62-81%]. CONCLUSION Combined US and FNAC provides important information prior to SLNB in that both procedures identify metastases in the lymph nodes (sensitivity > 80%). Patients with positive FNAC may proceed directly to complete lymph node dissection (cLND) instead of having initial SLNB. Thus, combined US and FNAC may prevent unnecessary anesthesia and surgical management as well reduce costs. In our study 16% (19/121) fewer SLNB procedures were carried out, subsequently replaced by cLND. For patients with a negative combination of in vivo US and FNAC, SLNB remains the best diagnostic option.
Collapse
Affiliation(s)
- Christiane Voit
- Department of Dermatology of the Charité, Humboldt University, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Dalle S, Paulin C, Lapras V, Balme B, Ronger-Savle S, Thomas L. Fine-needle aspiration biopsy with ultrasound guidance in patients with malignant melanoma and palpable lymph nodes. Br J Dermatol 2007; 155:552-6. [PMID: 16911280 DOI: 10.1111/j.1365-2133.2006.07361.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recurrence after treatment of stage I-II melanoma involves regional lymph nodes in about 50% of patients. A reliable method is needed to evaluate lymph node status (metastatic or not) in the case of palpable lymph nodes. OBJECTIVES To evaluate the efficiency of fine-needle aspiration biopsy (FNAB) in examining clinically detected suspicious lymph node in patients followed up after surgical removal of stage I-II melanoma. PATIENTS AND METHODS One hundred and twenty FNABs were performed in 67 patients with a suspicious node in an open study conducted in a French melanoma regional referral centre, Hôpital de l'Hôtel-Dieu. Cytodiagnosis was classified as positive, negative, inadequate or inconclusive. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated after final histopathological evaluation. RESULTS Fifty-eight of 120 FNABs were positive (48%), 50 of 120 (42%) were negative, four of 120 (3%) were inconclusive and eight of 120 (7%) were inadequate. Among the 108 FNABs in which a definitive diagnosis could be given, sensitivity was 98.2% [95% confidence interval (CI) 90.7-99.9] and specificity was 96.1% (95% CI 86.8-98.9). CONCLUSIONS FNAB under ultrasound guidance is an efficient tool to discriminate better between cases in which surgical treatment of the lymph node basin should be performed and patients who should return for follow-up. Surgical treatment appears to be required in cases of positive FNAB or in inconclusive cases.
Collapse
Affiliation(s)
- S Dalle
- Service de Radiologie, Hôpital de l'Hôtel-Dieu, 1 Place de l'Hôpital, 69288 Lyon Cedex 02, France.
| | | | | | | | | | | |
Collapse
|
37
|
Voit C, Kron M, Schwürzer-Voit M, Sterry W. Intradermal injection of Newcastle disease virus-modified autologous melanoma cell lysate and interleukin-2 for adjuvant treatment of melanoma patients with resectable stage III disease. J Dtsch Dermatol Ges 2005; 1:120-5. [PMID: 16285179 DOI: 10.1046/j.1610-0387.2003.02014.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The value of active specific immunotherapy (ASI) for the treatment of solid tumours still has to be assessed. The objective was to test an autologous tumour cell vaccine for adjuvant treatment of stage III melanoma patients. PATIENTS AND METHODS After open vaccination of 12 patients, another 17 patients were recruited for a randomized double-blind trial comparing treatment with the vaccine (n = 9) and with a placebo (n = 8). Intracutaneous vaccinations were given postoperatively in weeks 2, 4, 6, 12, 24 and thereafter every 6 months if sufficient vaccine material was available. Patients were followed for 60-84 months. RESULTS Median disease-free survival time was 5 months for open-treated, 4 months for verum-treated and 6 months for placebo-treated patients. Corresponding median overall survival times were 30.5, 18 and 18.5 months, respectively. There were no remarkable differences between the verum and the placebo group. CONCLUSIONS Adjuvant treatment of melanoma patients with an autologous ASI vaccine did not show clinical efficacy in this cohort of melanoma patients.
Collapse
Affiliation(s)
- Christiane Voit
- Department of Dermatology of the Charité, Humboldt-University, Berlin, Germany.
| | | | | | | |
Collapse
|
38
|
Références. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
39
|
Bafounta ML, Beauchet A, Chagnon S, Saiag P. Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis. Lancet Oncol 2004; 5:673-80. [PMID: 15522655 DOI: 10.1016/s1470-2045(04)01609-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Because treatment of distant melanoma metastases is not very effective, nodal spread should be diagnosed early so that therapeutic lymphadenectomy can be started as early as possible. Physical examination alone often does not detect nodal metastases and palpable nodes cannot be clasified unambiguously. Whether lymph-node ultrasonography-an inexpensive procedure-improves detection of nodal invasion during the initial staging and follow-up of patients with melanoma is controversial. We used meta-analysis techniques for diagnostic tests to assess the merit of ultrasonography and palpation in detection of nodal invasion in patients with melanoma. Five databases were screened until December, 2003. 12 studies, including 6642 patients and 18?610 paired palpation and ultrasound examinations, were eligible. The main limitations were variations in the definition of false negatives, and verification bias. Ultrasonography had a higher discriminatory power (odds ratio 1755; 95% CI 726-4238) than did palpation (21 [4-111]; p=0.0001). Furthermore, positive-likelihood ratios were 41.9 (95% CI 29-75) for ultrasonography and 4.55 (2-18) for palpation; negative-likelihood ratios were 0.024 (0.01-0.03) and 0.22 (0.06-0.31), respectively. Our results showed clearly that ultrasonography detects lymph-node invasion more accurately than palpation, and should therefore probably be used routinely in patients with melanoma.
Collapse
Affiliation(s)
- Marie-Lise Bafounta
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UFR Médecine Paris-Ile-de-France Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Boulogne, France
| | | | | | | |
Collapse
|
40
|
Guitera P, Bourrier P, Basset-Seguin N, Dubertret L. L’échographie devrait devenir l’examen de référence dans la détection de l’atteinte ganglionnaire du mélanome. Ann Dermatol Venereol 2004; 131:937-9. [PMID: 15602377 DOI: 10.1016/s0151-9638(04)93800-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
41
|
Affiliation(s)
- Janak N Shah
- Gastroenterology Division, Department of Medicine, University of Pennsylvania Cancer Center, University of Pennsylvania Health System, Philadelphia, USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
Melanoma is a devastating disease frequently encountered within both veterinary and human medicine. Molecular changes linked with neoplastic transformation of melanocytes include mutations in genes that encode proteins intrinsic to the regulatory pathways of two tumor suppressor proteins (retinoblastoma protein and p53), proto-oncogene mutation to oncogenes, altered expression of epithelial cadherin and CD44 adhesion molecules, and upregulation of angiogenic factors and other growth factors. Histologic evaluation of the primary mass is the most common means of diagnosis, with cytology used more frequently to document metastasis. Melanoma's highly variable histologic and cytologic patterns can make diagnosis by either method problematic. Adherent epithelioid morphology, including signet ring forms, and nonadherent round and spindle forms are recognized, with pigmentation an inconsistent finding. The site of the tumor, the thickness of the primary tumor or depth of invasion, and the number of mitotic figures per high-power field or per millimeter are used histologically to predict biologic behavior, whereas site and degree of pleomorphism are typically used for cytologic preparations. Diagnosis of amelanotic melanoma can be aided by ancillary diagnostic techniques. Tumor cells are usually positive for vimentin, S100, neuron-specific enolase, and Melan-A, and negative for cytokeratin. Melan-A as a positive marker is not as sensitive as the others are but is likely more specific. Monoclonal antibodies to human melanosome-specific antigens 1 and 5 cross-react with canine antigens for a combined sensitivity rate of 83%. Mouse monoclonal antibody IBF9 specifically recognizes canine melanoma antigen and also has good sensitivity. Serologic markers, including cytokines, cell adhesion molecules, and melanoma-inhibitory activity, are being investigated as potential sentinels of melanoma. Currently, there is no single diagnostic technique capable of differentiating benign from malignant melanocytic neoplasms or predicting survival time.
Collapse
Affiliation(s)
- S H Smith
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
43
|
Abstract
Melanoma is a significant health problem. Despite public education and free cancer screenings, the incidence and mortality of melanoma continues to rise; however, many currently diagnosed melanomas are thin lesions, suggesting that education and awareness is having an impact. In addition, there are still subsets of patients who need increased surveillance in order to increase their survival. Although large congenital nevi may be precursors of melanoma, small and medium congenital nevi have an insignificant risk for melanoma development. Large congenital nevi, which are axial in location, appear to be more likely to develop melanoma and are associated with melanocytosis and melanoma of the CNS, both of which portend a poor prognosis. Recently, the recommended margins of excision have become more conservative so that many of the surgical defects can be closed primarily. Lymphoscintigraphy and sentinel node biopsy have replaced elective node dissections, thus decreasing the morbidity associated with the surgical management of melanoma. Although controversy still exists as to whether or not sentinel lymph node biopsy alters a patient's prognosis, it has been shown to be a powerful prognostic indicator. Although most melanomas are managed by routine surgical excision, other modalities are sometimes employed. For example, cryosurgery or radiation therapy may be indicated in the frail, elderly individual with a large facial lentigo maligna. Mohs surgery is the treatment of choice for head and neck melanomas and those located in areas where maximum preservation of tissue is required and for desmoplastic and acral lentiginous melanomas. Much more work remains in the area of adjuvant therapy, chemotherapy, and immunotherapy. Dacarbazine remains the drug of choice in disseminated melanoma, but remissions are usually short lived. Interleukin and biochemotherapy has yielded good results but the percentage benefiting is small. Although high dose interferon increases disease-free and overall survival in some patients, it remains a controversial drug which is not easily tolerated. In the new staging system for melanoma, ulceration is second only to Breslow's thickness. In transit (satellite) lesions have also been included in this new system. The new system also recognizes that patients with only microscopic metastatic nodal disease fare better than patients with clinically enlarged metastatic nodes and that it is the number of nodes involved with metastases, not their size, that determines the patient's prognosis. Except for lesions <1mm thick, the Clark's level of invasion has been de-emphasized.
Collapse
Affiliation(s)
- Pearon G Lang
- Medical University of South Carolina, Charleston, South Carolina 29925, USA
| |
Collapse
|
44
|
Voit C, Schoengen A, Schwürzer-Voit M, Weber L, Ulrich J, Sterry W, Proebstle TM. The role of ultrasound in detection and management of regional disease in melanoma patients. Semin Oncol 2002; 29:353-60. [PMID: 12170438 DOI: 10.1053/sonc.2002.34113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Melanoma follow-up programs are directed towards early detection of tumor recurrence. Because the majority of first relapses occur in the regional lymph node area, special focus is placed on this region using various techniques in addition to physical examination. During the last several years, particularly ultrasound B-scan has evolved as a technique of major importance for detection of such regional melanoma recurrences. The technique shows high sensitivity and specificity, discriminating regional or subcutaneous melanoma metastases from nonspecific nodes. Furthermore, suspicious findings can be evaluated quickly and reliably by the minimally invasive technique of ultrasound-guided fine-needle aspiration cytology (FNAC). For regional metastases located deeply or close to vulnerable structures, the new method of ultrasound-guided anchor-wire-marking facilitates subsequent surgery. In summary, ultrasound B-scan has become an essential technique in the follow-up of melanoma patients.
Collapse
Affiliation(s)
- Christiane Voit
- Department of Dermatology, Charité, Humboldt University of Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
45
|
Voit C, Proebstle TM, Winter H, Kimmritz J, Kron M, Sterry W, Schwürzer M. Presurgical ultrasound-guided anchor-wire marking of soft tissue metastases in stage III melanoma patients. Dermatol Surg 2001; 27:129-32. [PMID: 11207684 DOI: 10.1046/j.1524-4725.2001.00213.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to increased sensitivity of diagnostic procedures, soft tissue metastases in melanoma patients are frequently detected very early. However, small sizes, deep location, or position close to vulnerable structures could render subsequent surgery quite difficult. OBJECTIVE To test the feasibility and effectiveness of presurgical ultrasound-guided anchor-wire marking of melanoma metastases. METHODS We selected melanoma patients with cytologically proven metastases in clinical stage III which were either unfavorably located or which have failed removal by previous surgery. Anchor-wire marking was performed ultrasound guided and free-hand style without the use of local anesthesia. RESULTS Twelve procedures in nine patients were well tolerated without any complications. In 11 cases the wire tip proved to be located within the tumor lesion; in one case the wire tip missed the target by less than 5 mm and thus was close enough to support appropriate surgery. Earlier, 3 of the 12 study lesions had undergone unsuccessful surgery. The median diameter of the removed metastases was 18.5 mm (range 7-30 mm). CONCLUSION Ultrasound-guided anchor-wire marking of unfavorably located melanoma metastases is feasible and might facilitate subsequent surgery.
Collapse
Affiliation(s)
- C Voit
- Department of Dermatology, Charité, Humboldt University of Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
46
|
Presurgical Ultrasound-Guided Anchor-Wire Marking of Soft Tissue Metastases in Stage III Melanoma Patients. Dermatol Surg 2001. [DOI: 10.1097/00042728-200102000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|