Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients

Caroline Asirvatham Gjorup; Helle Westergren Hendel; Rita Kaae Pilegaard; Cecilie Balslev Willert; Lisbet Rosenkrantz Hölmich

Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients

Caroline Asirvatham Gjorup, Helle Westergren Hendel, Rita Kaae Pilegaard, Cecilie Balslev Willert, Lisbet Rosenkrantz Hölmich

Department of Clinical Medicine

2 Citations (Scopus)

Abstract

Introduction: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified. Methods: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014. Results: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8% and the negative predictive value was 100%. Conclusion: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.

Original language	English
Article number	A5317
Journal	Danish Medical Journal
Volume	63
Issue number	12
Number of pages	4
ISSN	1603-9629
Publication status	Published - Dec 2016

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
False Negative Reactions
Female
Follow-Up Studies
Humans
Lung Neoplasms
Male
Melanoma
Middle Aged
Neoplasm Staging
Predictive Value of Tests
Preoperative Period
Radiography, Thoracic
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin Neoplasms
Young Adult
Journal Article

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title = "Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients",

abstract = "Introduction: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified. Methods: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014. Results: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8% and the negative predictive value was 100%. Conclusion: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, False Negative Reactions, Female, Follow-Up Studies, Humans, Lung Neoplasms, Male, Melanoma, Middle Aged, Neoplasm Staging, Predictive Value of Tests, Preoperative Period, Radiography, Thoracic, Retrospective Studies, Sentinel Lymph Node Biopsy, Skin Neoplasms, Young Adult, Journal Article",

author = "Gjorup, {Caroline Asirvatham} and Hendel, {Helle Westergren} and Pilegaard, {Rita Kaae} and Willert, {Cecilie Balslev} and H{\"o}lmich, {Lisbet Rosenkrantz}",

year = "2016",

month = dec,

language = "English",

volume = "63",

journal = "Danish Medical Journal",

issn = "1603-9629",

publisher = "Almindelige Danske Laegeforening",

number = "12",

}

TY - JOUR

T1 - Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients

AU - Gjorup, Caroline Asirvatham

AU - Hendel, Helle Westergren

AU - Pilegaard, Rita Kaae

AU - Willert, Cecilie Balslev

AU - Hölmich, Lisbet Rosenkrantz

PY - 2016/12

Y1 - 2016/12

N2 - Introduction: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified. Methods: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014. Results: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8% and the negative predictive value was 100%. Conclusion: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.

AB - Introduction: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified. Methods: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014. Results: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8% and the negative predictive value was 100%. Conclusion: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.

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KW - Aged

KW - Aged, 80 and over

KW - False Negative Reactions

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lung Neoplasms

KW - Male

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KW - Middle Aged

KW - Neoplasm Staging

KW - Predictive Value of Tests

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Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients

Abstract

Keywords

UN SDGs

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