title: The contribution of high-resolution ultrasonography in preoperatively detecting sentinel-node metastases in melanoma patients.
abstract: To evaluate the ability of high-resolution ultrasonography (hrUS) to detect sentinel-node (SN) melanoma metastases preoperatively before sentinel-node biopsy (SNB), to define hrUS resolution, and to evaluate which US criteria should be used. During a 6.5-year period, 131 consecutive patients with 132 >or=1-mm thick or ulcerated cutaneous melanomas, who were followed up at a single center, were enrolled. All patients underwent preoperative regional lymph-node hrUS and SNB. We used the recently evaluated ultrasonographic stringent and nonstringent hrUS criteria to detect SN metastases. Sizes of the SN metastatic deposits were measured under light microscopy. Thirty-five (27%) patients had a positive SNB. HrUS identified only three positive SNs as being metastatic. Sensitivity and specificity using stringent criteria were 8.8% [95% confidence interval (CI, 2.3-24.8%) and 95.9% (95% CI, 89.3-98.7%)], respectively. Positive-predictive value was 42.9% (95% CI, 11.9-79.9%). The nonstringent criteria provided four additional true-positive results, but lowered specificity (89.8%; 95% CI, 81.6-94.7%) with no significant improvement in sensitivity (20.6%; 95% CI, 9.3-38.4%). Positive-predictive value using nonstringent criteria was 41.2% (95% CI, 19.3-66.4%). HrUS failed to detect all metastatic deposits <5 mm in diameter. HrUS assessment of early-stage melanomas cannot replace surgical SNB. Owing to its low positive-predictive value, hrUS was unable to identify patients who would have to proceed directly to completion lymphadenectomy.
authors.affiliation: Department of Dermatology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France. claire.sibon@apr.aphp.fr
authors.forename: Claire
authors.initials: C
authors.lastname: Sibon
authors.forename: Sophie
authors.initials: S
authors.lastname: Chagnon
authors.forename: Arnold
authors.initials: A
authors.lastname: Tchakérian
authors.forename: Marie-Lise
authors.initials: ML
authors.lastname: Bafounta
authors.forename: Christine
authors.initials: C
authors.lastname: Longvert
authors.forename: Thierry
authors.initials: T
authors.lastname: Clerici
authors.forename: Ute
authors.initials: U
authors.lastname: Zimmermann
authors.forename: Philippe
authors.initials: P
authors.lastname: Saiag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000628:therapy; D008875:Middle Aged; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D014463:Ultrasonography / Q000379:methods*