Top

Published in:

01-11-2006

Ultrasonography and Fine-needle Aspiration Cytology in the Preoperative Evaluation of Melanoma Patients Eligible for Sentinel Node Biopsy

Authors: Maartje C. van Rijk, MD, H. Jelle Teertstra, MD, PhD, Johannes L. Peterse, MD, Omgo E. Nieweg, MD, PhD, Renato A. Valdés Olmos, MD, PhD, Cornelis A. Hoefnagel, MD, PhD, Bin B. R. Kroon, MD, PhD, FRCS

Published in: Annals of Surgical Oncology | Issue 11/2006

Abstract

Background

Ultrasonography with fine-needle aspiration cytology (FNAC) has proven to be a valuable diagnostic tool in the preoperative workup of patients with breast cancer or penile cancer eligible for sentinel lymph node biopsy. The aim of this study was to evaluate the use of this technique in the initial assessment of patients with primary cutaneous melanoma.

Methods

A total of 107 patients with cutaneous melanoma eligible for sentinel node biopsy with clinically negative nodes were studied prospectively. Patients underwent ultrasonography of potentially involved basins and FNAC in case of a suspicious lymph node. The sentinel node procedure was omitted in patients with tumour-positive lymph nodes in lieu of lymph node dissection.

Results

Ultrasonography with FNAC correctly identified disease preoperatively in two of the 107 patients (2%). Thirteen of the 22 patients (59%) with a suspicious node on ultrasonographic imaging but a tumour-negative fine-needle aspirate were shown to have involved nodes. Of the 85 patients with ultrasonographically normal nodes, 25 (29%) were shown to have metastases. Of the total of 43 involved basins, 16 contained metastases > 2 mm and 25 ≤ 2 mm.

Conclusions

In our hands, the sensitivity and specificity of preoperative ultrasonography to detect lymph node involvement in patients with melanoma are 34% and 87%, respectively. In combination with FNAC, this is 4.7% and 100%, respectively. This yield is insufficient for this technique to be used as a routine diagnostic tool in the selection of patients eligible for sentinel node biopsy.

Starritt EC, Uren RF, Scolyer RA, et al. Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol 2005; 12:18–23CrossRefPubMed

Voit CA, Mayer T, Schäfer G, Gellrich S, Kron M, Sterry M, Schwürzer M, Schoengen A. Ultrasound (US) and Ultrasound Guided Fine Needle Aspiration Cytology (FNAC) reduces surgical procedures, sentinel node (SN) dissection in melanoma patients and reliably predicts lymph node involvement in cutaneous lymphoma patients. Conference Proceeding American Society of Clinical Oncology 2005. Available: http://www.asco.org/ac/1,1003,_12-002643-00_18-0034-00_19-0030946,00.asp (accessed January 9, 2006)

Rossi CR, Mocellin S, Scagnet B, et al. The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients. J Surg Oncol 2003; 83:80–4CrossRefPubMed

Bonnema J, Van Geel AN, Van Ooijen B, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg 1997; 21:270–4CrossRefPubMed

De Kanter AY, Van Eijck CHJ, Van Geel AN, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 1999; 86:1459–62CrossRefPubMed

Hall TB, Barton DP, Trott PA, et al. The role of ultrasound-guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: 5-year experience in 44 patients. Clin Radiol 2003; 58:367–71CrossRefPubMed

Deurloo EE, Tanis PJ, Gilhuijs KG, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 2003; 39:1068–73CrossRefPubMed

Kroon BK, Horenblas S, Deurloo EE, et al. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU Int 2005; 95:517–21CrossRefPubMed

Van den Brekel MW, Castelijns JA, Snow GB. The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? Am J Neuroradiol 1998; 19:695–700PubMed

10.

Estourgie SH, Nieweg OE, Valdés Olmos RA, et al. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 2003; 10:681–8CrossRefPubMed

11.

Nieweg OE, Tanis PJ, Kroon BBR. The definition of a sentinel node. Ann Surg Oncol 2001; 8:538–41CrossRefPubMed

12.

Starz H, Balda BR, Kramer KU, et al. A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001; 91:2110–21CrossRefPubMed

13.

Cole WH. Efforts to explain spontaneous regression of cancer. J Surg Oncol 1981; 17:201–9PubMed

14.

Morton. Interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) in clinical stage I melanoma. Conference Proceeding of the American Society of Clinical Oncology 2005. Available: http://www.asco.org/ac/1,1003,_12-002511-00_18-0034-00_19-003013,00.asp (accessed January 9, 2006)

15.

Kretschmer L, Hilgers R, Mohrle M, et al. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. Eur J Cancer 2004; 40:212–8CrossRefPubMed

16.

Morton DL, Hoon DS, Cochran AJ, et al. Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg 2003; 238:538–49PubMed

17.

Hocevar M, Bracko M, Pogacnik A, et al. The role of preoperative ultrasonography in reducing the number of sentinel lymph node procedures in melanoma. Melanoma Res 2004; 14:533–6CrossRefPubMed

18.

Kahle B, Hoffend J, Wacker J, et al. Preoperative ultrasonographic identification of the sentinel lymph node in patients with malignant melanoma. Cancer 2003; 97:1947–54CrossRefPubMed

19.

Sapino A, Cassoni P, Zanon E, et al. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 2003; 88:702–6CrossRefPubMed

20.

Motomura K, Inaji H, Komoike Y, et al. Gamma probe and ultrasonographically-guided fine-needle aspiration biopsy of sentinel lymph nodes in breast cancer patients. Eur J Surg Oncol 2001; 27:141–5CrossRefPubMed

21.

Kuenen-Boumeester V, Menke-Pluymers M, De Kanter AY, et al. Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer 2003; 39:170–4CrossRef

22.

Bedrosian I, Bedi D, Kuerer HM, et al. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 2003; 10:1025–30CrossRefPubMed

23.

Dewar DJ, Newell B, Green MA, et al. The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004; 22:3345–9CrossRefPubMed

24.

Wagner JD, Schauwecker D, Davidson D, et al. Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer 2005; 104:570–9CrossRefPubMed

25.

Alonso O, Martinez M, Delgado L, et al. Comparison of 99mTc-MIBI scintigraphy and sentinel node biopsy in the detection of occult lymph node metastases from cutaneous melanoma. Eur J Dermatol 2003; 13:449–54PubMed

26.

Harisinghani MG, Barentsz J, Hahn PF, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003; 348:2491–9CrossRefPubMed

27.

Goldberg BB, Merton DA, Liu JB, et al. Sentinel lymph nodes in a swine model with melanoma: contrast-enhanced lymphatic US. Radiology 2004; 230:727–34PubMed

Title: Ultrasonography and Fine-needle Aspiration Cytology in the Preoperative Evaluation of Melanoma Patients Eligible for Sentinel Node Biopsy
Authors: Maartje C. van Rijk, MD
H. Jelle Teertstra, MD, PhD
Johannes L. Peterse, MD
Omgo E. Nieweg, MD, PhD
Renato A. Valdés Olmos, MD, PhD
Cornelis A. Hoefnagel, MD, PhD
Bin B. R. Kroon, MD, PhD, FRCS
Publication date: 01-11-2006
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9106-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Ultrasonography and Fine-needle Aspiration Cytology in the Preoperative Evaluation of Melanoma Patients Eligible for Sentinel Node Biopsy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2006

Upstaging and Improved Survival of Early Breast Cancer Patients after Implementation of Sentinel Node Biopsy for Axillary Staging

A Gene Expression Profile for Vascular Invasion can Predict the Recurrence After Resection of Hepatocellular Carcinoma: a Microarray Approach

Society of Surgical Oncology Heritage Award–Honoring Charles M. Balch, M.D

Evaluation of Preoperative Therapy for Pancreatic Cancer Using a Prognostic Nomogram

Bypass Surgery Versus Palliative Pancreaticoduodenectomy in Patients with Advanced Ductal Adenocarcinoma of the Pancreatic Head, with an Emphasis on Quality of Life Analyses

Prognosis of Breast Cancer After Supraclavicular Lymph Node Metastasis: Not a Distant Metastasis