title: Fine-needle aspiration cytology for the diagnosis of metastatic melanoma: systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a thorough review and meta-analysis of studies that have shown non-image-guided fine-needle aspiration cytology (FNAC) to be highly sensitive and specific for assessing questionable metastatic melanoma to lymph nodes.
  
  
  METHODS
  MEDLINE and Scopus were searched for potentially relevant articles with a search string including the words "melanoma" and "fine needle." All relevant articles were screened by two authors (B.J.H. and R.L.S.). Full articles were screened for extractable data, and the data was pooled for analysis.
  
  
  RESULTS
  Of 978 unique studies found, 10 (5,518 cases) met our inclusion criteria. In a pooled analysis of palpation and ultrasound-guided fine-needle aspirations, the area under the receiver operating characteristic curve was 0.99 (95% confidence interval [CI], 0.99-1.00). The summary estimates for the sensitivity and specificity were 0.97 (95% CI, 0.95-0.98) and 0.98 (95% CI, 0.98-1.00), respectively.
  
  
  CONCLUSIONS
  With a sensitivity and specificity of 0.97 and 0.99, the overall diagnostic accuracy of FNAC for metastatic melanoma is quite high, and with a positive and negative likelihood ratio of 58 and 0.03, FNAC for metastatic melanoma should be the first-line option in a patient with a clinically suspected mass and a history of melanoma.
authors.affiliation: Dept of Pathology, University of Utah School of Medicine, 15 N Medical Dr E, Salt Lake City, UT 84112; brian.hall@hsc.utah.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hall
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schmidt
authors.forename: Rohit R
authors.initials: RR
authors.lastname: Sharma
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Layfield
mesh_terms: D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000556:secondary*; D012372:ROC Curve; D015203:Reproducibility of Results; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D014463:Ultrasonography
keywords: AP cytopathology; Fine-needle aspiration; Melanoma; Meta-analysis; Metastatic melanoma; Surgical oncology; Systematic review