The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients.
OBJECTIVE
To evaluate the efficacy of preoperative ultrasound (US) scanning in identifying lymph node metastasis before sentinel node biopsy (SNB), we conducted a prospective study on 125 patients with primary cutaneous melanoma (CM).


METHODS
We prospectively enrolled 125 patients with >1 mm thick CM and candidate for SNB. Preoperatively, patients underwent US scanning of regional lymphatic basins and FNA of suspected lymph nodes (LN). All patients underwent lymphatic mapping and SNB.


RESULTS
Combined with fine-needle aspirate (FNA) of suspect LN, US scan allowed the correct preoperative detection of 12 out of 31 histologically positive lymphatic basins, specificity and sensitivity being 100 and 39%, respectively. The false negative rate (61%) was mainly linked to tumor deposits less than 2 mm in diameter, which can be considered the current spatial resolution limit of this technique.


CONCLUSIONS
Preoperative US scan could reduce the number of SNB, thus avoiding the stress of this surgical procedure in approximately 10% of patients and reducing health care costs. As a non-invasive and relatively inexpensive technique, lymph node US scan can be part of the preoperative staging process of patients' candidate for SNB in order to avoid unnecessary surgical procedures.
Rossi
Carlo Riccardo
CR
Department of Oncological and Surgical Sciences, Istituto di Clinica Chirurgica Generale II, Padova, Italy. carlor.rossi@unipd.it
Mocellin
Simone
S
Scagnet
Barbara
B
Foletto
Mirto
M
Vecchiato
Antonella
A
Pilati
Pierluigi
P
Tregnaghi
Alberto
A
Zavagno
Giorgio
G
Stramare
Roberto
R
Rubaltelli
Leopoldo
L
Montesco
Cristina
C
Borsato
Simonetta
S
Rubello
Domenico
D
Lise
Mario
M
D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000556:secondary; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography