title: Diagnostic accuracy of fine needle biopsy for metastatic melanoma and its implications for patient management.
abstract: BACKGROUND
  The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated.
  
  
  METHODS
  A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up.
  
  
  RESULTS
  FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results.
  
  
  CONCLUSIONS
  FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma.
authors.affiliation: Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Doubrovsky
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Paul R
authors.initials: PR
authors.lastname: McKenzie
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Watson
authors.forename: C Soon
authors.initials: CS
authors.lastname: Lee
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: McLeod
authors.forename: William H
authors.initials: WH
authors.lastname: McCarthy
authors.forename: Roger F
authors.initials: RF
authors.lastname: Uren
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.forename: Robyn P
authors.initials: RP
authors.lastname: Saw
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*