title: Long-term results of ultrasound guided fine needle aspiration cytology in conjunction with sentinel node biopsy support step-wise approach in melanoma.
abstract: BACKGROUND
  US-FNAC is a common diagnostic tool in the work-up of many cancers. Results in melanoma were initially poor (sensitivity 20-40%). Introduction of the Berlin Morphology criteria has shown potential improvement up to 65-80% in selected patients.
  
  
  OBJECTIVE
  This cohort study evaluates the long-term survival outcome of melanoma patients undergoing Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) prior to sentinel node biopsy (SNB) or direct lymphadenectomy.
  
  
  METHODS
  Between 2001 and 2010 over 1000 consecutive melanoma patients prospectively underwent targeted US-FNAC prior to SNB. The Berlin US morphology criteria: peripheral perfusion (PP), loss of central echoes (LCE) and balloon shape (BS) were registered. FNAC was performed if any factor was present. All patients underwent SNB or lymphadenectomy in case of positive FNAC.
  
  
  RESULTS
  Median follow-up was 61 months (IQR 40-95). SN positivity rate was 21%. Survival analyses demonstrated that patients with positive US-FNAC had poor survival. After adjustment for SN status and other known prognostic features, patients with positive US-FNAC (hazard ratio (HR) 1.80, 95% CI 1.10-2.96) had worse survival than patients with normal US (reference). Patients with suspicious US and negative FNAC (HR 1.13, 95% CI 0.71-1.78) had survival comparable to patients with normal US.
  
  
  CONCLUSIONS
  The long-term US-FNAC results support this step-wise approach to melanoma patients. Patients with positive US-FNAC have a poor survival and can be spared a SNB. Patients with suspicious US and negative FNAC should undergo SNB to detect microscopic occult disease. Completely US-FNAC negative patients might only require follow-up and no SN staging at all.
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075EA Rotterdam, The Netherlands. Electronic address: c.oudeophuis@erasmusmc.nl.
authors.forename: C M C
authors.initials: CMC
authors.lastname: Oude Ophuis
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075EA Rotterdam, The Netherlands. Electronic address: c.verhoef@erasmusmc.nl.
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075EA Rotterdam, The Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.
authors.forename: D J
authors.initials: DJ
authors.lastname: Grünhagen
authors.affiliation: Department of Dermatology, Charité-University of Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: petra.siegel@charite.de.
authors.forename: P
authors.initials: P
authors.lastname: Siegel
authors.affiliation: Department of Internal Medicine, Hematology and Medical Oncology, Armed Forces Hospital, Oberer Eselsberg 40, 89081 Ulm, Germany. Electronic address: Alfred.schoengen@t-online.de.
authors.forename: A
authors.initials: A
authors.lastname: Schoengen
authors.affiliation: Department of Dermatology, Charité-University of Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: joachim.roewert@charite.de.
authors.forename: J
authors.initials: J
authors.lastname: Röwert-Huber
authors.affiliation: Board of Directors, Cancer Institute Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif/Paris-Sud, France. Electronic address: Alexander.eggermont@gustaveroussy.fr.
authors.forename: A M M
authors.initials: AMM
authors.lastname: Eggermont
authors.affiliation: Department of Dermatology, Charité-University of Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: C A
authors.initials: CA
authors.lastname: Voit
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: a.v.akkooi@nki.nl.
authors.forename: A C J
authors.initials: ACJ
authors.lastname: van Akkooi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate; D018084:Ultrasonography, Interventional
keywords: Fine needle aspiration cytology FNAC; Melanoma; Prognosis; Sentinel node biopsy; Survival; Ultrasound/ultrasonography