title: Ultrasound-guided fine needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) allows early detection of metastases, thereby enabling early treatment in melanoma patients likely to benefit from adjuvant therapies. This prospective study analyzes the possible benefits of additional ultrasound (US) and fine needle aspiration cytology (FNAC) of sentinel nodes (SN) prior to SLNB.
  
  
  METHODS
  Over a 2-year period 127 melanoma patients with 151 SN were scheduled for SLNB. All SN were initially identified with lymphoscintigraphy, then identified and evaluated by US and the cells aspirated for cytology (FNAC). US findings and FNAC results were compared to surgical findings.
  
  
  RESULTS
  Of 127 patients, 114 had one SN each, 12 had two, and one had three. In vivo US achieved a sensitivity of 79% (95% CI: 62-91%) and a specificity of 72% (95% CI: 62-81%). FNAC showed a sensitivity of 59% (95% CI: 41-76%) and a specificity of 100% (95% CI: 95-100%). The combination of these two in vivo methods achieved an overall sensitivity of 82% (95% CI: 65-93%) and an overall specificity of 72% [95% CI: 62-81%].
  
  
  CONCLUSIONS
  Combined US and FNAC provides important information prior to SLNB in that both procedures identify metastases in the lymph nodes (sensitivity > 80%). Patients with positive FNAC may proceed directly to complete lymph node dissection (cLND) instead of having initial SLNB. Thus, combined US and FNAC may prevent unnecessary anesthesia and surgical management as well reduce costs. In our study 16% (19/121) fewer SLNB procedures were carried out, subsequently replaced by cLND. For patients with a negative combination of in vivo US and FNAC, SLNB remains the best diagnostic option.
authors.affiliation: Department of Dermatology of the Charité, Humboldt University, Berlin, Germany. christiane.voit@charite.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Voit
authors.forename: Martina
authors.initials: M
authors.lastname: Kron
authors.forename: Gregor
authors.initials: G
authors.lastname: Schäfer
authors.forename: Alfred
authors.initials: A
authors.lastname: Schoengen
authors.forename: Heike
authors.initials: H
authors.lastname: Audring
authors.forename: Ansgar
authors.initials: A
authors.lastname: Lukowsky
authors.forename: Markus
authors.initials: M
authors.lastname: Schwürzer-Voit
authors.forename: Wolfram
authors.initials: W
authors.lastname: Sterry
authors.forename: Helmut
authors.initials: H
authors.lastname: Winter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rademaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D003584:Cytological Techniques; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods*