title: Ultrasonography using simple diagnostic criteria vs palpation for the detection of regional lymph node metastases of melanoma.
abstract: OBJECTIVE
  Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma.
  
  
  METHODS
  Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation.
  
  
  METHODS
  Dermatology and radiology departments of a university hospital.
  
  
  METHODS
  A total of 160 new consecutive patients with stage I to stage III melanoma.
  
  
  METHODS
  Experienced operators independently performed 391 paired palpation and ultrasonographic examinations.
  
  
  METHODS
  Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious.
  
  
  RESULTS
  Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval [95% CI], 29.6-53.5) and 76.9% (95% CI, 66.7%-87.2%) (P<.001) and specificity was 95.7% (95% CI, 93.5%-97.9%) and 98.4% (95% CI, 97.1%-99.8%) (P<.05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% [95% CI, 82.5-89.9]) (P<.05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings.
  
  
  CONCLUSIONS
  Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.
authors.affiliation: Service de Dermatologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, Boulogne, France. philippe.saiag@apr.ap-hop-paris.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Saiag
authors.forename: Marion
authors.initials: M
authors.lastname: Bernard
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.forename: Marie-Lise
authors.initials: ML
authors.lastname: Bafounta
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bourgault-Villada
authors.forename: Sophie
authors.initials: S
authors.lastname: Chagnon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018608:Ultrasonography, Doppler