Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-negative Melanoma

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2011 Dec 24

PMID 22193886

Citations 3

Authors

Christy Y Chai

Jonathan S Zager

Margaret M Szabunio

Suroosh S Marzban

Alec Chau

Robert M Rossi

Vernon K Sondak

Affiliations

Soon will be listed here.

Abstract

Background: Sentinel lymph node biopsy (SLNB) is widely used in melanoma. Identifying nodal involvement preoperatively by high-resolution ultrasound may offer less invasive staging. This study assessed feasibility and staging results of clinically targeted ultrasound (before lymphoscintigraphy) compared to SLNB.

Methods: From 2005 to 2009, a total of 325 patients with melanoma underwent ultrasound before SLNB. We reviewed demographics and histopathologic characteristics, then compared ultrasound and SLNB results. Sensitivity, specificity, and positive and negative predictive value were determined.

Results: A total of 325 patients were included, 58% men and 42% women with a median age of 58 (range 18-86) years. A total of 471 basins were examined with ultrasound. Only six patients (1.8%) avoided SLNB by undergoing ultrasound-guided fine-needle aspiration of involved nodes, then therapeutic lymphadenectomy. Sixty-five patients (20.4%) had 69 SLNB positive nodal basins; 17 nodal basins from 15 patients with positive ultrasounds were considered truly positive. Forty-five SLNB positive basins had negative ultrasounds (falsely negative). Seven node-positive basins did not undergo ultrasound because of unpredicted drainage. A total of 253 patients with negative SLNBs had negative ultrasounds in 240 nodal basins (truly negative) but falsely positive ultrasounds occurred in 40 basins. Overall, sensitivity of ultrasound was 33.8%, specificity 85.7%, positive predictive value 36.5%, and negative predictive value 84.2%. Sensitivity and specificity improved somewhat with increasing Breslow depth. Sensitivity was highest for the neck, but specificity was highest for the groin.

Conclusions: Routine preoperative ultrasound in clinically node-negative melanoma is impractical because of its low sensitivity. Selected patients with thick or ulcerated lesions may benefit. Because of variable lymphatic drainage patterns, preoperative ultrasound without lymphoscintigraphic localization will provide incomplete evaluation in many cases.

Citing Articles

Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma.

Dinnes J, Ferrante di Ruffano L, Takwoingi Y, Cheung S, Nathan P, Matin R Cochrane Database Syst Rev. 2019; 7:CD012806.

PMID: 31260100 PMC: 6601698. DOI: 10.1002/14651858.CD012806.pub2.

Gamma probe and ultrasound guided fine needle aspiration cytology of the sentinel node (GULF) trial - overview of the literature, pilot and study protocol.

Oude Ophuis C, Koppert L, de Monye C, van Deurzen C, Koljenovic S, van Akkooi A BMC Cancer. 2017; 17(1):258.

PMID: 28403815 PMC: 5389093. DOI: 10.1186/s12885-017-3236-2.

Accuracy of real-time ultrasound elastography in the differential diagnosis of lymph nodes in cutaneous malignant melanoma (CMM): a pilot study.

Ogata D, Uematsu T, Yoshikawa S, Kiyohara Y Int J Clin Oncol. 2013; 19(4):716-21.

PMID: 23900625 DOI: 10.1007/s10147-013-0595-9.

References

Stebbins W, Garibyan L, Sober A . Sentinel lymph node biopsy and melanoma: 2010 update Part II. J Am Acad Dermatol. 2010; 62(5):737-48. DOI: 10.1016/j.jaad.2009.11.696. View

Voit C, van Akkooi A, Schafer-Hesterberg G, Schoengen A, Kowalczyk K, Roewert J . Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol. 2010; 28(5):847-52. DOI: 10.1200/JCO.2009.25.7428. View

Buzzell R, Zitelli J . Favorable prognostic factors in recurrent and metastatic melanoma. J Am Acad Dermatol. 1996; 34(5 Pt 1):798-803. DOI: 10.1016/s0190-9622(96)90017-1. View

Sanki A, Uren R, Moncrieff M, Tran K, Scolyer R, Lin H . 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(33):5614-9. DOI: 10.1200/JCO.2008.21.4882. View

van Akkooi A, Nowecki Z, Voit C, Schafer-Hesterberg G, Michej W, de Wilt J . Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008; 248(6):949-55. DOI: 10.1097/SLA.0b013e31818fefe0. View

Reynolds H, Dunbar P, Uren R, Blackett S, Thompson J, Smith N . Three-dimensional visualisation of lymphatic drainage patterns in patients with cutaneous melanoma. Lancet Oncol. 2007; 8(9):806-12. DOI: 10.1016/S1470-2045(07)70176-6. View

Schmid-Wendtner M, Paerschke G, Baumert J, Plewig G, Volkenandt M . Value of ultrasonography compared with physical examination for the detection of locoregional metastases in patients with cutaneous melanoma. Melanoma Res. 2003; 13(2):183-8. DOI: 10.1097/00008390-200304000-00012. View

Leong S, Kim J, Ross M, Faries M, Scoggins C, Metz W . A phase 2 study of (99m)Tc-tilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer. Ann Surg Oncol. 2011; 18(4):961-9. PMC: 3071527. DOI: 10.1245/s10434-010-1524-z. View

van Akkooi A, de Wilt J, Verhoef C, Graveland W, van Geel A, Kliffen M . High positive sentinel node identification rate by EORTC melanoma group protocol. Prognostic indicators of metastatic patterns after sentinel node biopsy in melanoma. Eur J Cancer. 2006; 42(3):372-80. DOI: 10.1016/j.ejca.2005.10.023. View

10.

van Akkooi A, Voit C, Verhoef C, Eggermont A . Potential cost-effectiveness of US-guided FNAC in melanoma patients as a primary procedure and in follow-up. Ann Surg Oncol. 2009; 17(2):660-2. PMC: 2816814. DOI: 10.1245/s10434-009-0807-8. View

11.

Uren R, Howman-Giles R, Thompson J, Shaw H, Roberts J, Bernard E . High-resolution ultrasound to diagnose melanoma metastases in patients with clinically palpable lymph nodes. Australas Radiol. 2000; 43(2):148-52. DOI: 10.1046/j.1440-1673.1999.00625.x. View

12.

Starritt E, Uren R, Scolyer R, Quinn M, Thompson J . Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol. 2005; 12(1):18-23. DOI: 10.1007/s10434-004-1163-3. View

13.

Thompson J, Uren R, Shaw H, McCarthy W, Quinn M, OBrien C . Location of sentinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg. 1999; 189(2):195-204. DOI: 10.1016/s1072-7515(99)00108-8. View

14.

van Akkooi A, Voit C, Verhoef C, Eggermont A . New developments in sentinel node staging in melanoma: controversies and alternatives. Curr Opin Oncol. 2010; 22(3):169-77. DOI: 10.1097/CCO.0b013e328337aa78. View

15.

Hocevar M, Bracko M, Pogacnik A, Vidergar-Kralj B, Besic N, Zgajnar J . The role of preoperative ultrasonography in reducing the number of sentinel lymph node procedures in melanoma. Melanoma Res. 2004; 14(6):533-6. DOI: 10.1097/00008390-200412000-00015. View

16.

Morton D, Thompson J, Cochran A, Mozzillo N, Elashoff R, Essner R . Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006; 355(13):1307-17. DOI: 10.1056/NEJMoa060992. View

17.

Sibon C, Chagnon S, Tchakerian A, Bafounta M, Longvert C, Clerici T . The contribution of high-resolution ultrasonography in preoperatively detecting sentinel-node metastases in melanoma patients. Melanoma Res. 2007; 17(4):233-7. DOI: 10.1097/CMR.0b013e3282c3a65a. View

18.

van Rijk M, Teertstra H, Peterse J, Nieweg O, Olmos R, Hoefnagel C . Ultrasonography and fine-needle aspiration cytology in the preoperative evaluation of melanoma patients eligible for sentinel node biopsy. Ann Surg Oncol. 2006; 13(11):1511-6. DOI: 10.1245/s10434-006-9106-9. View

19.

Rossi C, Mocellin S, Scagnet B, Foletto M, Vecchiato A, Pilati P . The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients. J Surg Oncol. 2003; 83(2):80-4. DOI: 10.1002/jso.10248. View

20.

Thompson J, Stretch J, Uren R, Ka V, Scolyer R . Sentinel node biopsy for melanoma: Where have we been and where are we going?. Ann Surg Oncol. 2004; 11(3 Suppl):147S-51S. DOI: 10.1007/BF02523619. View