title: High-resolution ultrasound combined with power Doppler sonography can reduce the number of sentinel lymph node biopsies in cutaneous melanoma.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with cutaneous melanoma. Disadvantages of the SLNB procedure are the overall costs and potential side effects of the operation [J Dtsch Dermatol Ges 2009;7:318-327; J Am Dermatol 2010;62:737-748].
  
  
  OBJECTIVE
  The purpose of our study was to evaluate whether high-resolution ultrasound combined with power Doppler sonography (PDS) is an appropriate tool for preoperative identification and characterization of sentinel lymph nodes (SLNs) in patients with cutaneous melanoma.
  
  
  METHODS
  In a prospective study eighty-one consecutive patients with cutaneous melanoma (33 females and 48 males) in whom dissection of SLNs was indicated underwent ultrasound examinations before and after the preoperative lymphoscintigraphy.
  
  
  RESULTS
  A total of 170 SLNs (mean 2.1 per patient) were removed and examined by histopathology. High resolution ultrasound combined with PDS correctly identified 2 of 9 positive SLNs. The sensitivity, specificity, positive predictive value, and negative predictive values of ultrasound were 22.2% (95% confidence interval (CI) = 2.8-60.0), 100% (95% CI = 97.7-100.0), 100.0% (95% CI = 15.8-100.0), and 95.8% (95% CI = 91.6-98.3), respectively.
  
  
  CONCLUSIONS
  Although high-resolution ultrasound combined with PDS cannot substitute SLNB, this technique offers earlier diagnosis of lymph node involvement in a small subgroup of patients (with subcapsular location of metastases), and introduces the possibility to exclude those patients from SLN procedure and directly prepare them for complete lymph node dissection (CLND).
authors.affiliation: Department of Dermatology and Allergology, Center of Integrated Oncology Cologne Bonn, University of Bonn, Bonn, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Hinz
authors.forename: Dagmar
authors.initials: D
authors.lastname: Wilsmann-Theis
authors.forename: Andrea
authors.initials: A
authors.lastname: Buchner
authors.forename: Joerg
authors.initials: J
authors.lastname: Wenzel
authors.forename: Clemens-M
authors.initials: CM
authors.lastname: Wendtner
authors.forename: Thomas
authors.initials: T
authors.lastname: Bieber
authors.forename: Guenter
authors.initials: G
authors.lastname: Reinhard
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.forename: Monika-H
authors.initials: MH
authors.lastname: Schmid-Wendtner
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018608:Ultrasonography, Doppler