Risk factors for positive sentinel lymph node, lymphatic or hematogenous dissemination over time in patients with cutaneous melanoma

The aim of the present study was to assess the influence of localization, age or sex and histopathological characteristics upon the chance of developing lymphatic or hematogenous metastatic spread over time, or a positive sentinel lymph node in cutaneous melanoma patients. Patients from the Department of Dermatology, County Emergency Hospital Cluj-Napoca (Cluj-Napoca, Romania), presenting with cutaneous melanoma confirmed histopathologically and a SPECT/CT or lymphoscintigraphic examination to detect the sentinel lymph node, were included in the present study. Our results revealed that Breslow index >2 mm [odds ratio (OR)=4.22, 95% confidence interval (CI) (1.12; 15.93)], presence of ulceration [OR=6.01, 95% CI (1.87; 19.35)], and positive sentinel lymph node [for at least one sentinel lymph node OR=3.58, 95% CI (1.06; 12.04)] were risk factors for hematogenous metastases. All these, except for the Breslow index >2 mm, were demonstrated to be a risk factor for lymphatic spread metastases over time. Ulceration and male sex also represented risk factors for a positive sentinel lymph node, men having a higher risk of developing sentinel lymph nodes than women [adjusted OR=2.27, 95% CI (1.00; 5.13)]. In conclusion, the predictors that influence the occurrence of lymphatic or hematogenous metastases may differ, ulceration and positive sentinel lymph node being common for both types of metastatic spread, while Breslow index being a significant predictor only for hematogenous metastases. Male sex and the presence of ulceration were demonstrated to be significant risk factors for positive sentinel lymph nodes.

The accuracy of elastographic strain ratio and ultrasound thickness in the differentiation of thin and thick cutaneous melanoma

Background

Cutaneous melanoma is the most deadly of skin neoplasms. Few studies have investigated the role of elastography characteristics so the ability of elastography in the differentiation of thin and thick cutaneous melanoma is still narrow.

Purpose

To investigate the accuracy of elastography in differentiating thin and thick melanoma, by measuring strain ratio (SR) between the lesion and adjacent dermis and hypodermis.

Material and Methods

We investigated by ultrasound and elastography 52 melanoma lesions in 49 patients. The receiver operating characteristic (ROC) curve method was used to investigate the accuracy of ultrasound and elastographic measurement of SR to surrounding tissue, in the differentiation of thin and thick melanomas. The histopathological measurement of lesions depth called Breslow index was the golden standard test.

Results

Areas under the curve (AUC) showed low accuracy for SR to hypodermis in distinguishing between thin melanomas and others (AUC = 0.739, 95% confidence interval [CI] = 0.508–0.970]) with a cut-off value of 0.950, being the only statistically significant result in matter of elastographic measurements. Highly statistically significant results were obtained for B-mode ultrasound depth measurements of the lesion, with an AUC = 0.970 (95% CI = 0.927–1.0) in discriminating thin melanomas of others and 0.951 (95% CI = 0.869–1.0) in discriminating thick melanomas of other types.

Conclusion

Despite the appearance that SR may correlate with the depth of the lesion, elastography, by measuring the SRs to dermis and hypodermis, does not have enough accuracy in distinguishing thin and thick melanoma.

Musculoskeletal ultrasound versus MRI of the hands in healthy subjects - a pilot study

AIM

High resolution imaging methods detect a spectrum of inflammatory-like and structural modifications at joint and tendon level in healthy subjects. The knowledge of their extent and degree is important when subclinical disease activity (implying therapy reassessment) must be differentiated from normality. Musculoskeletal ultrasound (MSUS) evaluation may be challenging even for experts when borderline or low grade lesions are present. Our objective was to analyse the frequency of inflammatory-like lesions in hand joint and tendons in healthy young subjects and to evaluate the concordance between MSUSand magnetic resonance imaging (MRI) findings.

MATERIAL AND METHODS

Ten healthy young women (age range 24-32 years) clinically asymptomatic (joints and tendons) were selected to have bilateral hand MSUS and MRI evaluation. Based on current definitions, synovitis/tenosynovitis-like lesions, erosions, osteophytes and bone edema were quantified and concordance between the two imaging methods was calculated.

RESULTS

Overall, both imaging evaluation methods showed a low frequency of inflammatory-like and structural lesions. No joint presented power Doppler signal or erosions. No abnormalities suggestive for inflammatory or structural pathology were detected at the tendon compartments level. No erosions and no signs of osteitis were detected. The concordance between MSUS and MRI findings was high except for the wrist area.

CONCLUSION

MSUS was demonstrated to be a very accurate imaging method, mostly for hand tendon evaluation. This would allow a better discrimination between normality and pathologic findings, adding supplementary information.

TennCare up and running

Tennessee's brand new program is the first of its kind tried by any state to bring managed care and Medicaid together. Here are the details of the model program along with expert opinions of the possible outcomes.

Changes in eye tracking during clinical stabilization in schizophrenia

Eye tracking abnormalities have been proposed as a trait marker for schizophrenia on the basis of their familial prevalence and the consistency of tracking over time in clinically stable patients. However, few studies have examined stability through acute episodes of illness, and most studies have not analyzed changes in different forms of eye movements. Therefore, the authors examined eye tracking, clinical state, and neuroleptic dose during 4 consecutive weeks in nine recently hospitalized schizophrenic patients. For the patients and controls, qualitative ratings of pursuit accuracy remained relatively stable over time. In contrast, saccade frequency increased significantly, with a 57% increase in small saccades and a 77% reduction in larger saccades. In comparison with cross-sectional studies which have found no correlation between neuroleptic dose and tracking performance, a reduction in large saccades was strongly correlated with increase in neuroleptic dose. The findings suggest that pursuit accuracy may be a trait characteristic of schizophrenia, while the frequency and size of saccades are state dependent characteristics.

The association between eye-tracking dysfunctions and thought disorder in psychosis

The relationship between the presence of smooth-pursuit eye-movement dysfunctions and degree of thought disorder was assessed in four groups: schizophrenics, manics, atypical psychotic patients, and normal persons. A positive relationship, constant for all groups, was found to be significant but low. Impaired eye tracking accounted for 4.22% of the total variance of thought disorder. Diagnosis accounted for over 10% of the thought-disorder variance. Although there is a tendency for those persons with poor eye tracking to have higher amounts of thought disorder than those with unimpaired eye tracking, all psychotic patients, regardless of diagnostic class, tended to have thought disorder scores in the pathological range, as measured by the Thought Disorder Index. Although the data may be viewed as supporting similar hypothetical processes that underlie pursuit dysfunctions and thought disorder, the greater likelihood exists that the coupling of thought disorder and eye-tracking dysfunctions may be explained differently in the schizophrenia and in the major affective disorders.