Can High-Resolution Ultrasound Avoid the Sentinel Lymph-node Biopsy Procedure in the Staging Process of Patients with Stage I–II Cutaneous Melanoma?

 

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Abstract

Purpose: The objective of our study was to define the diagnostic accuracy of high-resolution ultrasound (US) in detecting nodal involvement before sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma, to define the sonographic criteria used to assess nodal metastases, and to establish if high-resolution US can directly select patients to radical lymphadenectomy, sparing selective lymphadenectomy.

Materials and Methods: 623 patients underwent high-resolution US of the regional lymph nodes, 24 hours prior being submitted to the sentinel lymph node biopsy procedure. The US findings were compared with histological findings.

Results: In 14.7 % out of 122 excised lymph nodes, high-resolution US showed sonographic features consistent with malignant involvement before the surgical step. US scan sensitivity and specificity were 15 and 100 %, respectively, since positive and negative predictive values were 100 and 87 % respectively.

Conclusion: US is an effective modality in the presurgical detection of subclinical deposits within sentinel lymph nodes. However, preoperative staging work-up with high-resolution US cannot substitute the SLNB, mainly because of low sensitivity due to missing many micrometastases.

Zusammenfassung

Ziel: Das Ziel unserer Studie war es, die diagnostische Treffsicherheit des hochauflösenden Ultraschalls (US) zum Nachweis der Knotenbeteiligung vor einer Wächterlymphknoten-Biopsie (SLNB) bei Patienten mit kutanem Melanom zu bestimmen, die sonografischen Kriterien für die Bewertung der Knotenmetastasen festzulegen und zu ermitteln, ob der hochauflösende US direkt Patienten für eine radikale Lymphadenektomie selektionieren kann, um sich die selektive Entfernung zu ersparen.

Material und Methoden: Bei 623 Patienten wurde ein hochauflösender US der regionalen Lymphknoten durchgeführt, 24 Stunden bevor diese sich der Prozedur einer Biopsie der Wächterlymphknoten unterzogen. Die US Befunde wurden mit den histologischen Befunden verglichen.

Ergebnisse: Bei 14,7 % der 122 untersuchten Lymphknoten zeigte der hochauflösende US vor dem chirurgischen Eingriff sonografische Zeichen in Übereinstimmung mit der malignen Beteiligung. Die Sensitivität der US-Untersuchung betrug 15 %, die Spezifität 100 %, während der positive Vorhersagewert 100 %, der negative Vorhersagewert 87 % erreichte.

Schlussfolgerung: US ist ein wirksames Verfahren zum Nachweis von subklinischen Ablagerungen innerhalb der Wächterlymphknoten vor einer Chirurgie. Allerdings kann die präoperative Stadieneinteilung mittels hochauflösenden US eine SLNB nicht ersetzen, vor allem aufgrund dessen niedriger Sensitivität, die auf das Nichtauffinden von vielen Mikrometastasen zurückzuführen ist.

• References

• 1 Morton DL, Thompson JF, Cochran AJ et al. MSLT Group Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355: 1307-1317
  CrossrefPubMedGoogle Scholar
• 2 van Akkooi AC, Voit CA, Verhoef C et al. New developments in sentinel node staging in melanoma: controversies and alternatives. Curr Opin Oncol 2010; 22: 169-177
  CrossrefPubMedGoogle Scholar
• 3 Wrightson WR, Wong SL, Edwards MJ et al. Sunbelt Melanoma Trial Study Group Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 2003; 10: 676-680
  CrossrefPubMedGoogle Scholar
• 4 Jansen L, Nieweg OE, Peterse JL et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg 2000; 87: 484-489
  CrossrefPubMedGoogle Scholar
• 5 Caracò C, Marone U, Celentano E et al. Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma. Ann Surg Oncol 2007; 14: 2662-2667
  CrossrefPubMedGoogle Scholar
• 6 Lam TK, Uren RF, Scolyer RA et al. False-negative sentinel node biopsy because of obstruction of lymphatics by metastatic melanoma: the value of ultrasound in conjunction with preoperative lymphoscintigraphy. Melanoma Res 2009; 19: 94-99
  CrossrefPubMedGoogle Scholar
• 7 Starritt EC, Uren RF, Scolyer RA et al. Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol 2005; 12: 18-23
  CrossrefPubMedGoogle Scholar
• 8 Kahle B, Hoffend J, Wacker J et al. Preoperative ultrasonographic identification of the sentinel lymph node in patients with malignant melanoma. Cancer 2003; 97: 1947-1954
  CrossrefPubMedGoogle Scholar
• 9 Rossi CR, Mocellin S, Scagnet B et al. The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients. J Surg Oncol 2003; 83: 80-84
  CrossrefPubMedGoogle Scholar
• 10 Voit CA, van Akkoi AC, Schäfer-Hesterberg G et al. Rotterdam Criteria for sentinel node (SN) tumor burden and the accuracy of ultrasound (US)-guided fine-needle aspiration cytology (FNAC): can US-guided FNAC replace SN staging in patients with melanoma?. J Clin Oncol 2009; 27: 4994-5000
  CrossrefPubMedGoogle Scholar
• 11 Mamou J, Coron A, Hata M et al. Three-dimensional high-frequency characterization of cancerous lymph nodes. Ultrasound Med Biol 2010; 36: 361-375
  CrossrefPubMedGoogle Scholar
• 12 Catalano O, Caracò C, Mozzillo N et al. Locoregional spread of cutaneous melanoma: sonography findings. Am J Roentgenol 2010; 194: 735-745
  CrossrefPubMedGoogle Scholar
• 13 Catalano O, Setola SV, Vallone P et al. Sonography for locoregional staging and follow-up of cutaneous melanoma. J Ultrasound Med 2010; 29: 791-802
  CrossrefPubMedGoogle Scholar
• 14 Govindarajan A, Ghazarian DM, McCready DR et al. Histological features of melanoma sentinel lymph node metastases associated with status of the completion lymphadenectomy and rate of subsequent relapse. Ann Surg Oncol 2007; 14: 906-912
  CrossrefPubMedGoogle Scholar
• 15 Catalano O. Critical analysis of the ultrasonographic criteria for diagnosing lymph node metastasis in patients with cutaneous melanoma: a systematic review. J Ultrasound Med 2011; 30: 547-560
  PubMedGoogle Scholar
• 16 Catalano O, Voit C, Sandomenico F et al. Previously reported sonographic appearances of regional melanoma metastases are not likely due to necrosis. J Ultrasound Med 2011; 30: 1041-1049
  PubMedGoogle Scholar
• 17 Voit CA, van Akkooi ACJ, Catalano O. Letter to the editor. Ultraschall in Med 2011; 32: 210-211
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Rossi CR, Scagnet B, Vecchiato A et al. Sentinel node biopsy and ultrasound scanning in cutaneous melanoma: clinical and technical considerations. Eur J Cancer 2000; 36: 895-900
  CrossrefPubMedGoogle Scholar
• 19 Testori A, Lazzaro G, Baldini F et al. The role of ultrasound of sentinel nodes in the pre- and post-operative evaluation of stage I melanoma patients. Melanoma Res 2005; 15: 191-198
  CrossrefPubMedGoogle Scholar
• 20 Hocevar M, Bracko M, Pogacnik A et al. The role of preoperative ultrasonography in reducing the number of sentinel lymph node procedures in melanoma. Melanoma Res 2004; 14: 533-536
  CrossrefPubMedGoogle Scholar
• 21 van Rijk MC, Jelle Teertstra H, Peterse JL et al. Ultrasonography and fine-needle aspiration cytology in the preoperative evaluation of melanoma patients eligible for sentinel node biopsy. Ann Surg Oncol 2006; 13: 1511-1516
  CrossrefPubMedGoogle Scholar
• 22 Sibon C, Chagnon S, Tchakérian A et al. The contribution of high-resolution ultrasonography in preoperatively detecting sentinel-node metastases in melanoma patients. Melanoma Res 2007; 17: 233-237
  CrossrefPubMedGoogle Scholar
• 23 Sanki A, Uren RF, Moncrieff M et al. 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: 5614-5619
  CrossrefPubMedGoogle Scholar
• 24 Kunte C, Schuh T, Eberle JY et al. The use of high-resolution ultrasonography for preoperative detection of metastases in sentinel lymph nodes of patients with cutaneous melanoma. Dermatol Surg 2009; 35: 1757-1765
  CrossrefPubMedGoogle Scholar
• 25 Uren RF, Sanki A, Thompson JF. The utility of ultrasound in patients with melanoma. Expert Rev Anticancer Ther 2007; 7: 1633-1642
  CrossrefPubMedGoogle Scholar
• 26 Voit C, Kron M, Schäfer G et al. Ultrasound-guided fine-needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol 2006; 13: 1682-1689
  CrossrefPubMedGoogle Scholar
• 27 Voit C, van Akkooi AC, Schafer-Hesterberg G et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol 2010; 28: 847-852
  CrossrefPubMedGoogle Scholar
• 28 Voit C, van Akkooi AJC, Siegel P et al. Ultrasound (US) guided fine needle aspiration cytology (FNAC) predicts sentinel node (SN) metastases and improves the nomogram for melanoma patients. Eur J Cancer 2011; 47: 652
  PubMedGoogle Scholar