Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma

Christiane Voit, Alexander C.J. Van Akkooi, Gregor Schäfer-Hesterberg, Alfred Schoengen, Katharina Kowalczyk, Joachim C. Roewert, Wolfram Sterry, Alexander M.M. Eggermont

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

120 Citaten (Scopus)

Samenvatting

Purpose: We have shown that ultrasound (US) -guided fine needle aspiration cytology (FNAC) can accurately identify the sentinel node (SN). Moreover, US-guided FNAC before the surgical SN procedure could identify up to 65% of all SN metastases. Herein we analyzed in detail the different US morphologic patterns of SN metastases. Patients and Methods: From July 2001 to December 2007, a total of 650 patients with melanoma scheduled for sentinel lymph node dissection were examined. We present the first 400 with sufficient follow-up (mean 40, median 39 months). Several morphologic characteristics were scored. In case of suspicious/ clearly malignant US patterns a FNAC was performed. The final histology was considered the gold standard. Results: Median Breslow was 1.8 mm. The sensitivity and positive predictive value of the most important factors were: peripheral perfusion (PP) present (77% and 52%, respectively), loss of central echoes (LCE; 60% and 65% respectively), and balloon shape (BS; 30% and 96% respectively). Together these factors have a sensitivity of 82% and PPV of 52% (P < .001). PP identified more patients with lower volume disease. PP and combined BS and LCE were independent prognostic factors for survival (hazard ratio, 2.19; P < .015; and hazard ratio, 5.50; P < .001, respectively). Conclusion: Preoperative US and FNAC can identify 65% of SN metastases and thus reduce the need for surgical SN procedures. Peripheral perfusion is an early sign of involvement and of crucial importance to achieve a high identification rate. Balloon shape and loss of central echoes are late signs of metastases. We recommend US evaluation to identify those patients, who can directly proceed to a complete lymph node dissection after a positive US-guided FNAC of the SN.

Originele taal-2Engels
Pagina's (van-tot)847-852
Aantal pagina's6
TijdschriftJournal of Clinical Oncology
Volume28
Nummer van het tijdschrift5
DOI's
StatusGepubliceerd - 10 feb. 2010
Extern gepubliceerdJa

Vingerafdruk

Duik in de onderzoeksthema's van 'Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma'. Samen vormen ze een unieke vingerafdruk.

Citeer dit