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

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.

Key words

soft tissues - skin - lymphatic - tumor

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