Targeted ultrasound and fine-needle aspiration cytology for sentinel node diagnostics in early-stage melanoma: a validation study

TY - JOUR

T1 - Targeted ultrasound and fine-needle aspiration cytology for sentinel node diagnostics in early-stage melanoma

T2 - a validation study

AU - Ternov, Niels K

AU - Lambine, Trine-Lise

AU - Wagenblast, Anne L H

AU - Clasen-Linde, Erik

AU - Oturai, Peter S.

AU - Klyver, Helle

AU - Nielsen, Kristina R

AU - Nielsen, Michael B.

AU - Drzewiecki, Krzysztof T.

AU - Chakera, Annette H.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is used to evaluate the involvement of lymph nodes in various malignant diseases. Its value in detecting sentinel lymph node (SN) metastasis preoperatively in melanoma patients is controversial and is the subject of this study. In this prospective validation study, 91 consecutive patients with melanoma clinical stage I (n=64) and II (n=27) were examined with US-FNAC before SN biopsy from 2012 to 2014 at a tertiary center. All patients underwent lymphoscintigraphy before the US-FNAC. Lymph nodes that showed any of the Berlin morphologic criteria on ultrasonography were examined using FNAC. The median Breslow thickness of the melanomas was 1.22 mm (range: 0.47-11.5 mm). Twenty-two percent of the patients had metastases in their SNs, 90% of which were smaller than 2 mm in largest diameter. The percentages of metastases with a size more than 1 mm were 50 and 29%, respectively, in the true-positive and false-negative US groups. The sensitivity, specificity, positive predictive value, and negative predictive value for overall US examination were 30, 81, 24, and 83%, respectively. None of the FNACs contained conclusive malignant cells. The specificity of the FNAC was 76%. Our results show that US-FNAC was not a useful diagnostic tool in our setting as it did not add significantly to the staging and management of patients with mainly thin cutaneous melanomas, perhaps because of the often small size of the SN metastases. It may be useful in the early diagnosis of lymph node metastases in a subgroup of melanoma patients with larger metastases.

AB - Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is used to evaluate the involvement of lymph nodes in various malignant diseases. Its value in detecting sentinel lymph node (SN) metastasis preoperatively in melanoma patients is controversial and is the subject of this study. In this prospective validation study, 91 consecutive patients with melanoma clinical stage I (n=64) and II (n=27) were examined with US-FNAC before SN biopsy from 2012 to 2014 at a tertiary center. All patients underwent lymphoscintigraphy before the US-FNAC. Lymph nodes that showed any of the Berlin morphologic criteria on ultrasonography were examined using FNAC. The median Breslow thickness of the melanomas was 1.22 mm (range: 0.47-11.5 mm). Twenty-two percent of the patients had metastases in their SNs, 90% of which were smaller than 2 mm in largest diameter. The percentages of metastases with a size more than 1 mm were 50 and 29%, respectively, in the true-positive and false-negative US groups. The sensitivity, specificity, positive predictive value, and negative predictive value for overall US examination were 30, 81, 24, and 83%, respectively. None of the FNACs contained conclusive malignant cells. The specificity of the FNAC was 76%. Our results show that US-FNAC was not a useful diagnostic tool in our setting as it did not add significantly to the staging and management of patients with mainly thin cutaneous melanomas, perhaps because of the often small size of the SN metastases. It may be useful in the early diagnosis of lymph node metastases in a subgroup of melanoma patients with larger metastases.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biopsy, Fine-Needle/methods

KW - Female

KW - Humans

KW - Male

KW - Melanoma/diagnosis

KW - Middle Aged

KW - Neoplasm Staging

KW - Prospective Studies

KW - Sentinel Lymph Node/surgery

KW - Skin Neoplasms/diagnosis

KW - Ultrasonography/methods

KW - Validation Studies as Topic

KW - Young Adult

U2 - 10.1097/CMR.0000000000000448

DO - 10.1097/CMR.0000000000000448

M3 - Journal article

C2 - 29595571

SN - 0960-8931

VL - 28

SP - 319

EP - 325

JO - Melanoma Research

JF - Melanoma Research

IS - 4

ER -