title: Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma.
abstract: PURPOSE We have shown that ultrasound (US) -guided fine needle aspiration cytology (FNAC) can accurately identify the sentinel node (SN). Moreover, US-guided FNAC before the surgical SN procedure could identify up to 65% of all SN metastases. Herein we analyzed in detail the different US morphologic patterns of SN metastases. PATIENTS AND METHODS From July 2001 to December 2007, a total of 650 patients with melanoma scheduled for sentinel lymph node dissection were examined. We present the first 400 with sufficient follow-up (mean 40, median 39 months). Several morphologic characteristics were scored. In case of suspicious/clearly malignant US patterns a FNAC was performed. The final histology was considered the gold standard. Results Median Breslow was 1.8 mm. The sensitivity and positive predictive value of the most important factors were: peripheral perfusion (PP) present (77% and 52%, respectively), loss of central echoes (LCE; 60% and 65% respectively), and balloon shape (BS; 30% and 96% respectively). Together these factors have a sensitivity of 82% and PPV of 52% (P < .001). PP identified more patients with lower volume disease. PP and combined BS and LCE were independent prognostic factors for survival (hazard ratio, 2.19; P < .015; and hazard ratio, 5.50; P < .001, respectively). CONCLUSION Preoperative US and FNAC can identify 65% of SN metastases and thus reduce the need for surgical SN procedures. Peripheral perfusion is an early sign of involvement and of crucial importance to achieve a high identification rate. Balloon shape and loss of central echoes are late signs of metastases. We recommend US evaluation to identify those patients, who can directly proceed to a complete lymph node dissection after a positive US-guided FNAC of the SN.
authors.affiliation: Department of Dermatology, Charité, University Medicine Berlin, Berlin, 10117, Germany. christiane.voit@t-online.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Voit
authors.forename: Alexander C J
authors.initials: AC
authors.lastname: Van Akkooi
authors.forename: Gregor
authors.initials: G
authors.lastname: Schäfer-Hesterberg
authors.forename: Alfred
authors.initials: A
authors.lastname: Schoengen
authors.forename: Katharina
authors.initials: K
authors.lastname: Kowalczyk
authors.forename: Joachim C
authors.initials: JC
authors.lastname: Roewert
authors.forename: Wolfram
authors.initials: W
authors.lastname: Sterry
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013997:Time Factors; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional