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Louie L, Wise J, Berl A, Shir‐az O, Kravtsov V, Yakhini Z, Shalom A, Golberg A, Vitkin E. High-throughput lipidomic profiles sampled with electroporation-based biopsy differentiate healthy skin, cutaneous squamous cell carcinoma, and basal cell carcinoma. Skin Res Technol 2024; 30:e13706. [PMID: 38721854 PMCID: PMC11079884 DOI: 10.1111/srt.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The incidence rates of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) skin cancers are rising, while the current diagnostic process is time-consuming. We describe the development of a novel approach to high-throughput sampling of tissue lipids using electroporation-based biopsy, termed e-biopsy. We report on the ability of the e-biopsy technique to harvest large amounts of lipids from human skin samples. MATERIALS AND METHODS Here, 168 lipids were reliably identified from 12 patients providing a total of 13 samples. The extracted lipids were profiled with ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS-MS) providing cSCC, BCC, and healthy skin lipidomic profiles. RESULTS Comparative analysis identified 27 differentially expressed lipids (p < 0.05). The general profile trend is low diglycerides in both cSCC and BCC, high phospholipids in BCC, and high lyso-phospholipids in cSCC compared to healthy skin tissue samples. CONCLUSION The results contribute to the growing body of knowledge that can potentially lead to novel insights into these skin cancers and demonstrate the potential of the e-biopsy technique for the analysis of lipidomic profiles of human skin tissues.
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Affiliation(s)
- Leetal Louie
- Porter School of Environment and Earth SciencesTel Aviv UniversityTel AvivIsrael
| | - Julia Wise
- Porter School of Environment and Earth SciencesTel Aviv UniversityTel AvivIsrael
| | - Ariel Berl
- Department of Plastic SurgeryMeir Medical CenterKfar SavaIsrael
| | - Ofir Shir‐az
- Department of Plastic SurgeryMeir Medical CenterKfar SavaIsrael
| | | | - Zohar Yakhini
- Arazi School of Computer ScienceReichman UniversityHerzliyaIsrael
- Department of Computer ScienceTechnion ‐ Israel Institute of TechnologyHaifaIsrael
| | - Avshalom Shalom
- Department of Plastic SurgeryMeir Medical CenterKfar SavaIsrael
| | - Alexander Golberg
- Porter School of Environment and Earth SciencesTel Aviv UniversityTel AvivIsrael
| | - Edward Vitkin
- Porter School of Environment and Earth SciencesTel Aviv UniversityTel AvivIsrael
- Arazi School of Computer ScienceReichman UniversityHerzliyaIsrael
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2
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Allard-Coutu A, Dobson V, Schmitz E, Shah H, Nessim C. The Evolution of the Sentinel Node Biopsy in Melanoma. Life (Basel) 2023; 13:life13020489. [PMID: 36836846 PMCID: PMC9966203 DOI: 10.3390/life13020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.
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Affiliation(s)
- Alexandra Allard-Coutu
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Erika Schmitz
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Hely Shah
- Department of Medical Oncology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Carolyn Nessim
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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3
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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.
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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)
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4
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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
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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: 13] [Impact Index Per Article: 6.5] [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.
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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
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6
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Overview of Subcutaneous Metastatic Melanoma. Cancers (Basel) 2021; 13:cancers13092063. [PMID: 33922905 PMCID: PMC8123140 DOI: 10.3390/cancers13092063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
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7
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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.
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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
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8
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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.
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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
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9
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Tsai KK, Pampaloni MH, Hope C, Algazi AP, Ljung BM, Pincus L, Daud AI. Increased FDG avidity in lymphoid tissue associated with response to combined immune checkpoint blockade. J Immunother Cancer 2016; 4:58. [PMID: 27660712 PMCID: PMC5028983 DOI: 10.1186/s40425-016-0162-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/31/2016] [Indexed: 12/26/2022] Open
Abstract
Background Antibodies against programmed death 1 (PD-1) receptor and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have transformed the systemic treatment of melanoma and many other cancers. Understanding the spectrum of benign findings and atypical response patterns seen in immune checkpoint blockade is important for accurately assessing treatment response as these immunotherapies become more widely used. Case presentation We report a 63-year-old man with metastatic melanoma successfully treated with combination CTLA-4 and PD-1 blockade (ipilimumab and nivolumab), after non-response to pembrolizumab monotherapy. The initial impression of disease progression, based on cutaneous and PET/CT findings of increased fluoro-2-deoxy-D-glucose (FDG) uptake in benign lymphoid tissue, proved to be erroneous after assiduous review of radiographic imaging and correlative pathology. Conclusions These findings indicate that increased FDG uptake in benign lymphoid tissue seen on PET/CT may be a surrogate marker of immune activation and treatment response. Prospective studies will be invaluable in validating immune-related radiographic findings as a prognostic biomarker of response in cancer patients being treated with immune checkpoint blockade.
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Affiliation(s)
- Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, Box 1770, San Francisco, CA 94115 USA
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94117 USA
| | - Charity Hope
- Department of Dermatology, University of California, San Francisco, 1701 Divisadero Street, San Francisco, CA 94115 USA
| | - Alain P Algazi
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, Box 1770, San Francisco, CA 94115 USA
| | - Britt-Marie Ljung
- Department of Pathology, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94115 USA
| | - Laura Pincus
- Department of Dermatology, University of California, San Francisco, 1701 Divisadero Street, San Francisco, CA 94115 USA
| | - Adil I Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, Box 1770, San Francisco, CA 94115 USA
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10
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Biernacka A, Linos KD, DeLong PA, Suriawinata AA, Padmanabhan V, Liu X. A case of S-100 negative melanoma: A diagnostic pitfall in the workup of a poorly differentiated metastatic tumor of unknown origin. Cytojournal 2016; 13:21. [PMID: 27729935 PMCID: PMC5040106 DOI: 10.4103/1742-6413.190914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/03/2016] [Indexed: 01/28/2023] Open
Abstract
When confronted with a metastatic poorly differentiated tumor of unknown origin, the initial workup includes the standard panel of immunostains to rule out carcinoma, sarcoma, lymphoma, and the greatest mimicker in pathology - malignant melanoma. Although not specific, the S-100 protein is expressed in over 95% of malignant melanomas. Herein, we present a case of multiorgan metastatic malignancy with a dominant hilar and mediastinal mass in a current smoker; clinically, highly suggestive of widespread primary lung cancer. This case was eventually classified as malignant melanoma, despite a significant diagnostic challenge due to lack of prior history, unusual cytomorphology, and S-100 protein negativity. A battery of immunostains was performed and the addition of other melanocytic-associated markers confirmed the melanocytic lineage of the neoplasm. This case highlights the pitfalls in the differential diagnosis of a metastatic tumor of unknown origin by fine needle aspiration cytology due to the significant morphologic overlap of poorly differentiated malignancies. We emphasize that, albeit rare, malignant melanomas can be completely negative for S-100 protein and the use of additional melanocytic-associated markers in the differential workup maybe critical in arriving promptly at a proper diagnosis. We also briefly discuss other currently available immunohistochemical markers that can assist in the identification of the S-100 negative melanoma.
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Affiliation(s)
- Anna Biernacka
- Address: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon
| | - Konstantinos D Linos
- Address: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Peter A DeLong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Pulmonary Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon
| | - Arief A Suriawinata
- Address: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Vijayalakshmi Padmanabhan
- Address: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Xiaoying Liu
- Address: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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11
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Scalp Melanoma Diagnosed by Fine Needle Aspiration Cytology in a Tertiary Health Center. Case Rep Oncol Med 2015; 2015:605906. [PMID: 26664783 PMCID: PMC4664796 DOI: 10.1155/2015/605906] [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: 07/30/2015] [Accepted: 10/27/2015] [Indexed: 11/18/2022] Open
Abstract
Melanoma is one of the most aggressive malignant skin neoplasms worldwide with more than 20% of world melanoma seen in black Africa and Asia. Late presentation due to ignorance, poverty, and lack of adequate health facility in Nigeria is always the norms. We present this case report because of precision in diagnosis, using fine needle aspiration cytology (FNAC) to reemphasize that the technique is cheap, cost effective, and quick that can reduce the burden of incisional biopsy before definitive surgery and improve early detection of the disease especially in developing countries.
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12
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Dinnes J, Matin RN, Moreau JF, Patel L, Chan SA, Chuchu N, Bayliss SE, Grainge M, Takwoingi Y, Davenport C, Walter FM, Fleming C, Schofield J, Shroff N, Godfrey K, O'Sullivan C, Deeks JJ, Williams HC. Tests to assist in the diagnosis of cutaneous melanoma in adults: a generic protocol. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011902] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jac Dinnes
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Rubeta N Matin
- Churchill Hospital; Department of Dermatology; Old Road Headington Oxford UK OX3 7LJ
| | - Jacqueline F Moreau
- University of Pittsburgh Medical Center; Internal Medicine; Department of Medicine, Office of Education UPMC Montefiore Hospital, N715 Pittsburgh USA PA, 15213
| | - Lopa Patel
- Royal Stoke Hospital; Plastic Surgery; Stoke-on-Trent Staffordshire UK ST4 6QG
| | - Sue Ann Chan
- NHS; Dermatology; 104 Times Square Avenue Brierley Hill Dudley UK DY5 1SX
| | - Naomi Chuchu
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Susan E Bayliss
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Matthew Grainge
- School of Community Health Sciences; Division of Epidemiology and Public Health; University of Nottingham Nottingham UK NG7 2UH
| | - Yemisi Takwoingi
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Clare Davenport
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Fiona M Walter
- University of Cambridge; Public Health & Primary Care; Strangeways Research Laboratory, Worts Causeway Cambridge UK CB1 8RN
| | - Colin Fleming
- NHS Tayside, Ninewells Hospital; Dermatology; Ninewells Drive Dundee UK DD1 9SY
| | - Julia Schofield
- United Lincolnshire Hospitals NHS Trust; Dermatology; Greetwell Street Lincoln UK LN2 5QY
| | - Neil Shroff
- Keyworth Medical Practice; Bunny Lane Keyworth Nottingham UK NG12 5JU
| | - Kathie Godfrey
- The University of Nottingham; c/o Cochrane Skin Group; Nottingham UK
| | | | - Jonathan J Deeks
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Hywel C Williams
- The University of Nottingham; Centre of Evidence Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
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13
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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.
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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
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Chen L, Raza AS, Simental RG, Iverson KT, Cobb CJ. Cytoplasmic vacuoles: Clue in the fine-needle aspiration diagnosis of melanoma. Diagn Cytopathol 2013; 42:143-6. [DOI: 10.1002/dc.23018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 04/04/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Liansong Chen
- Department of Pathology; Los Angeles County + University of Southern California Medical Center; Los Angeles California
| | - Anwar S. Raza
- Department of Pathology; Los Angeles County + University of Southern California Medical Center; Los Angeles California
- Department of Pathology; Loma Linda University Medical Center; Loma Linda California
| | - Raul G. Simental
- Department of Pathology; Los Angeles County + University of Southern California Medical Center; Los Angeles California
- Department of Pathology; USC Keck School of Medicine; Los Angeles California
| | - Kiva T. Iverson
- Department of Pathology; Los Angeles County + University of Southern California Medical Center; Los Angeles California
| | - Camilla J. Cobb
- Department of Pathology; Los Angeles County + University of Southern California Medical Center; Los Angeles California
- Department of Pathology; Loma Linda University Medical Center; Loma Linda California
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15
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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.
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Affiliation(s)
- M G Özden
- Department of Dermatology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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16
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Johnson RL, Hasteh F. Thyroid cyst wall atypia in a patient with a history of malignant melanoma: a pitfall in fine-needle aspiration cytology. Diagn Cytopathol 2012; 41:716-9. [PMID: 22351646 DOI: 10.1002/dc.21843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/27/2011] [Indexed: 11/06/2022]
Abstract
We present an interesting case report from a patient with a history of desmoplastic malignant melanoma (MM), who presented with a thyroid nodule. The patient's clinical diagnosis included a benign thyroid nodule versus a primary thyroid malignancy or metastatic MM. Fine-needle aspiration biopsy showed highly atypical spindle cells suspicious for metastatic MM. The acellular cell block prevented further studies such as immunohistochemical analysis. The patient underwent surgical excision of the mass, which showed a benign cystic thyroid nodule with an atypical cyst lining. Here, we report the presence of atypical cyst-lining cells in a patient with diagnosis of MM. The atypical cytology of the cyst-lining cells has been reported in the English literature; however, presence of significant cytological atypia, especially in a patient with a history of another malignancy, can be problematic. The cytopathologist should be aware of this entity and its diagnostic pitfalls.
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Affiliation(s)
- Rebecca L Johnson
- Department of Pathology, University of California, San Diego, California, USA
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17
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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]
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18
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19
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Kandil D, Leiman G, Allegretta M, Evans M. Glypican-3 protein expression in primary and metastatic melanoma: a combined immunohistochemistry and immunocytochemistry study. Cancer 2009; 117:271-8. [PMID: 19517479 DOI: 10.1002/cncy.20032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The incidence of melanoma is increasing. Fine-needle aspiration (FNA) is critical in documenting recurrent/metastatic disease in established cases. The potential of metastatic melanoma (MM) to mimic epithelial tumors presents a diagnostic dilemma. In liver FNA, the distinction between hepatocellular carcinoma (HCC) and MM is a frequent challenge. Glypican-3 (GPC3), a heparan sulfate proteoglycan, is a highly sensitive and specific marker for HCC. Serum GPC3 was shown to be expressed in 40% of primary melanomas (PMs), but to the authors' knowledge no tissue studies to date have assessed GPC3 expression in MM. In this study, GPC3 protein expression was investigated in FNAs from MM, and in corresponding histologic sections from the primary tumors. METHODS Sixty archival, direct FNA smears or CytoLyt-fixed samples from 50 patients with MM were retrieved together with formalin-fixed, paraffin-embedded specimens available from 17 corresponding PMs. All cases were stained with anti-GPC3 antibody. FNA and core biopsy specimens from HCCs and benign liver were used as positive and negative controls. GPC3 expression was divided into 2 categories: negative (negative or weak cytoplasmic staining) and positive (moderate or strong cytoplasmic with membranous accentuation). RESULTS All FNAs from MM cases were negative (0 of 60) for GPC3. The exact 95% Clopper-Pearson confidence interval was 0.0% to 5.96%. Only 1 case of PM (1 of 17; 5.9%) demonstrated weak focal cytoplasmic staining (regarded as negative). CONCLUSIONS In the current study, all MM and PM cases in archival FNAs and tissue sections were found to be negative for GPC3. These data suggest that GPC3 is not expressed in melanoma using the 1G12 clone.
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Affiliation(s)
- Dina Kandil
- Department of Pathology, University of Vermont, Burlington, Vermont, USA.
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20
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Lim J, Vadodaria S, Powell B. False positive diagnosis of malignant melanoma metastasis. J Plast Reconstr Aesthet Surg 2008; 61:218-20. [DOI: 10.1016/j.bjps.2007.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/16/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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21
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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.
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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
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22
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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.
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Affiliation(s)
- Rajmohan Murali
- Royal Prince Alfred Hospital, Department of Anatomical Pathology, Camperdown, NSW, 2050, Australia +61 2 9515 7011 ; +61 2 9515 8405 ;
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23
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Murali R, Doubrovsky A, Watson GF, McKenzie PR, Lee CS, McLeod DJ, Uren RF, Stretch JR, Saw RPM, Thompson JF, Scolyer RA. Diagnosis of metastatic melanoma by fine-needle biopsy: analysis of 2,204 cases. Am J Clin Pathol 2007; 127:385-97. [PMID: 17276948 DOI: 10.1309/3qr4fc5ppwxa7n29] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Fine-needle biopsy (FNB) has been reported as a rapid, minimally invasive technique for the diagnosis of metastatic melanoma. The diagnostic accuracy of FNB was assessed in a consecutive series of 2,204 FNBs of clinically suspicious lesions from patients with previous primary melanomas treated at the Sydney Melanoma Unit, Sydney, Australia, between January 1992 and December 2002. The sensitivity and specificity of FNB were 96.3% and 98.9%, respectively. There were 5 false-positive cases (0.6%), which were verified as metastatic adenocarcinoma (3 cases) or reactive processes (organizing hematoma and chronic osteomyelitis, 1 each). False-negative diagnoses (6.7% of cases) were associated with a variety of clinicopathologic factors, including difficult-to-access anatomic sites (eg, high axilla or deep inguinal), small lesions, and lesional characteristics such asfibrosis, necrosis, or cystic change. FNB is a highly accurate, rapid, and cost-effective procedure for the diagnosis of metastatic melanoma and should be considered as the initial diagnostic procedure of choice in patients with melanoma with clinically suspected metastases.
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Affiliation(s)
- Rajmohan Murali
- Department of Anatomical Pathology, Sydney Cancer Centre, Australia
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24
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Roux C, Petit B, Bouvier S, Sparsa A, Bedane C. C77 - Étude prospective de la cytoponction ganglionnaire dans les mélanomes stade III. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Oliveira AFD, Gragnani A, Oliveira Filho RS, Santos IDDAO, França SGD, Enokihara MMSES, Ferreira LM. [Experimental model of primary cultured metastatic melanoma by fine needle aspiration]. Acta Cir Bras 2005; 20:390-3. [PMID: 16186964 DOI: 10.1590/s0102-86502005000500009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Establish an experimental model of metastatic melanoma primary culture cells from fine-needle aspiration biopsies (FNAB). METHODS Two metastatic melanoma primary culture cells from (FNAB) have been developed from patients who had been submitted to excision of metastatic lesions and they were identified by immunohistochemical analyses using S-100 and MB-45 melanoma markers. RESULTS The culture diagnostic was confirmed by immunohistochemical. The technique of FNAB offers the advantage of providing a sequential analysis of the same tumor nodules throughout treatment, and is a minimally invasive procedure with almost no associated morbidity. CONCLUSION The establishment of metastatic melanoma primary culture from FNAB samples showed a viable technique.
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Affiliation(s)
- Andrea Fernandes de Oliveira
- Laboratório de Cultura de Células, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo.
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26
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Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Campo M, Picca G, Giorgino F. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13:1163-7. [PMID: 14751038 DOI: 10.1089/10507250360731578] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cystic changes in metastatic cervical lymph nodes (CLN) from papillary thyroid cancer (PTC) may be a diagnostic pitfall in fine-needle aspiration biopsy (FNAB) cytology. We investigated in a series of CLN metastases from thyroid cancers (TC), including cystic PTC, and from a wide spectrum of extrathyroidal malignancies, the diagnostic role for metastatic TC of the rapid detection of thyroglobulin in eluates from FNAB (FNAB-Tg) of CLN. The study was carried out in a group of 79 subjects (22/57 M/F; median age, 56 years; range, 20-86 years) with enlarged CLN and thyroid nodules (TN), examined for potential metastatic TC, and harboring a large spectrum of incidentally diagnosed extrathyroidal malignancies (n = 24, mostly represented by lymphomas, lung, and breast cancers), CLN metastases from thyroid cancers (n = 28, including 6 cystic metastatic PTC), 6 specific lymphadenitis and 21 reactive lymphadenitis mostly detected (n = 16) during follow-up of patients with previously ablated TC. Markedly high FNAB thyroglobulin (Tg) values were found in all metastatic CLN TC. Two of the six cases with cystic metastatic CLN PTC were diagnosed by FNAB-Tg but not by cytology. In conclusion, FNAB-Tg has been confirmed as an easy modality and fast procedure to diagnose CLN metastasis from TC and high FNAB-Tg values with nondiagnostic cystic cytology strongly suggest cystic metastatic PTC.
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Affiliation(s)
- M Cignarelli
- Cattedradi Endocrinologia e Malattie Metaboliche, Università degli Studi di Foggia, Foggia, Italy.
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Saqi A, McGrath CM, Skovronsky D, Yu GH. Cytomorphologic features of fine-needle aspiration of metastatic and recurrent melanoma. Diagn Cytopathol 2002; 27:286-90. [PMID: 12411994 DOI: 10.1002/dc.10194] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Melanoma is an aggressive malignancy with a growing prevalence. Although early detection and excision offer a potential cure, recurrences and metastases are not uncommon. Fine-needle aspiration (FNA) can play a vital role in their detection as a relatively noninvasive, rapid, and economical alternative for tracking disease evolution. Prior clinical history and classic cytological features of melanoma (loosely cohesive smear pattern and single cells with large nuclei, prominent nucleoli, and melanin pigment) aid in cytological diagnoses. However, not all melanomas contain melanin pigment or characteristic cytologic features. We examined a large series of melanoma cases to determine the incidence of melanin pigment, the most common cell morphology, and the presence or absence of apoptosis/necrosis associated with this highly aggressive neoplasm.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology and Laboratory Medicine, Cytopathology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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28
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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.
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Affiliation(s)
- S H Smith
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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29
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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.
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Affiliation(s)
- Pearon G Lang
- Medical University of South Carolina, Charleston, South Carolina 29925, USA
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Barkan GA, Rubin MA, Michael CW. Diagnosis of melanoma aspirates on ThinPrep: the University of Michigan experience. Diagn Cytopathol 2002; 26:334-9. [PMID: 11992379 DOI: 10.1002/dc.10099] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to compare the cytologic features of melanoma fine-needle aspirates (FNAs) prepared by ThinPrep (TP) with those in conventional smears (CS) and to identify any diagnostic pitfalls. Fifty-one aspirates diagnosed as melanoma were obtained, 36 of which were prepared by both TP and CS. The preparations were evaluated for cellularity, cell aggregates, cellular appearance, melanin pigment, cytoplasmic, and nuclear features. Categorical data were analyzed by the chi-square test and continuous data by the Wilcoxin-signed rank test. Correlation was determined by Spearman's test for bivariate correlations (rho). Good correlation between the two methods was identified for the following features: cellularity, cell type, bi/multinucleated cells, cytoplasmic features, NC ratio, and presence of macronucleoli. TP exhibits coarser chromatin compared to CS (P = 0.005). Six of 36 CS contained large cellular groups; none of the TP contained them (P = 0.018). Twenty-five of 36 CS contained intranuclear inclusions as opposed to 12/36 TP (P < 0.001). The number of inclusions was significantly reduced on TP. The amount of intracellular melanin was the same with both techniques. Background melanin was markedly reduced on TP except when either trapped by fibrin or attached to cellular clusters (P = 0.006). Background blood was also markedly reduced on TP (P < 0.005). In summary, the cytological features of TP and CS for FNA evaluation of melanoma correlate well; however, one needs to be aware of the cytologic alterations introduced by TP. TP is a sufficient preparation method in the diagnosis of melanoma FNA aspirates when performed by clinicians. It is also a useful adjunct in bloody or low-cellular aspirates, where it tends to reduce the background blood and concentrate the cells.
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Affiliation(s)
- Güliz Akdas Barkan
- Department of Pathology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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