title: The role of preoperative ultrasonography in reducing the number of sentinel lymph node procedures in melanoma.
abstract: Sentinel lymph node (SLN) biopsy is the most effective method to nodally stage patients with melanoma. However, SLN metastases are an indication for a complete regional lymphadenectomy. The aim of this study was to evaluate the ability of ultrasound (US) and US-guided fine needle aspiration biopsy (US-FNAB) to reduce the number of patients requiring a second surgical procedure. Fifty-seven patients with melanoma underwent preoperative US of the regional lymph nodes before SLN biopsy. In patients with US malignant lymph nodes, US-FNAB was performed. Only patients with cytologically proven lymph node metastases proceeded directly to a complete regional lymphadenectomy, whereas, in all others, SLN biopsy was performed. Fourteen patients (25%) had metastases in the regional lymph nodes. There were 40 benign and 17 malignant US results. US-FNAB was performed in 14 patients. It was positive in three, negative in nine and inadequate sampling was obtained in two. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US were 71%, 84%, 59% and 90%, respectively. US of the regional lymph nodes with US-FNAB enables the safe selection of patients who should proceed directly to a complete regional lymphadenectomy. However, the sensitivity and PPV of the method are low.
authors.affiliation: Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia. mhocevar@onko-i.si
authors.forename: Marko
authors.initials: M
authors.lastname: Hocevar
authors.forename: Matej
authors.initials: M
authors.lastname: Bracko
authors.forename: Ana
authors.initials: A
authors.lastname: Pogacnik
authors.forename: Barbara
authors.initials: B
authors.lastname: Vidergar-Kralj
authors.forename: Nikola
authors.initials: N
authors.lastname: Besic
authors.forename: Janez
authors.initials: J
authors.lastname: Zgajnar
authors.forename: Maja Marolt
authors.initials: MM
authors.lastname: Music
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002648:Child; 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; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography