Abstract
Background
The value of targeted high-resolution ultrasound (US) examination in detecting sentinel lymph node metastases in patients with newly diagnosed primary cutaneous melanomas has not yet been fully evaluated. The aim of this study was to determine the threshold size of metastatic melanoma deposits in SLNs able to be detected by targeted US examination before initial melanoma surgery.
Methods
A total of 304 patients presenting with primary cutaneous melanomas had SLNs identified by lymphoscintigraphy and then examined in situ by the same physician with high-resolution US. Within 24 hours, the SLNs were removed for histopathologic assessment of sections stained conventionally and with immunohistochemical markers for S100 protein and HMB45 antigen.
Results
Metastatic disease was present in SLNs from 33 node fields in 31 patients. The US results in seven of these cases were suggestive of metastatic disease. Twenty-six node fields contained positive nodes not detected by US. Undetected deposits had diameters <4.5 mm.
Conclusions
These results suggest that a targeted US examination of SLNs can detect metastatic melanoma deposits down to approximately 4.5 mm in diameter. However, most metastatic melanoma deposits in SLNs are considerably smaller than this at the time of initial staging, and US therefore cannot be considered cost-effective in this setting.
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References
CM Balch SJ Soong JE Gershenwald et al. (2001) ArticleTitlePrognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system J Clin Oncol 19 3622–34 Occurrence Handle1:STN:280:DC%2BD3MvlvV2ktA%3D%3D Occurrence Handle11504744
L Prayer H Winkelbauer N Gritzmann F Winkelbauer M Helmer H Pehamberger (1990) ArticleTitleSonography versus palpation in the detection of regional lymph-node metastases in patients with malignant melanoma Eur J Cancer 26 827–30 Occurrence Handle10.1016/0277-5379(90)90163-N Occurrence Handle1:STN:280:DyaK3M%2Fis1aqtQ%3D%3D Occurrence Handle2145905
M Binder H Kittler A Steiner R Dorffner K Wolff H Pehamberger (1997) ArticleTitleLymph node sonography versus palpation for detecting recurrent disease in patients with malignant melanoma Eur J Cancer 33 1805–8 Occurrence Handle1:STN:280:DyaK1c7jtFKisQ%3D%3D Occurrence Handle9470837
A Blum B Schlagenhauff W Stroebel H Breuninger G Rassner C Garbe (2000) ArticleTitleUltrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma: results of a prospective study of 1288 patients Cancer 88 2534–9 Occurrence Handle1:STN:280:DC%2BD3cvisFyrsg%3D%3D Occurrence Handle10861430
C Voit T Mayer M Kron et al. (2001) ArticleTitleEfficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients Cancer 91 2409–16 Occurrence Handle1:STN:280:DC%2BD3MzkvFGqsw%3D%3D Occurrence Handle11413532
MH Schmid-Wendtner G Paerschke J Baumert G Plewig M Volkenandt (2003) ArticleTitleValue of ultrasonography compared with physical examination for the detection of locoregional metastases in patients with cutaneous melanoma Melanoma Res 13 183–8 Occurrence Handle12690303
P Vassallo K Wernecke N Roos PE Peters (1992) ArticleTitleDifferentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US Radiology 183 215–20 Occurrence Handle1:STN:280:DyaK387ps1aqtA%3D%3D Occurrence Handle1549675
RF Uren R Howman-Giles JF Thompson et al. (1999) ArticleTitleHigh-resolution ultrasound to diagnose melanoma metastases in patients with clinically palpable lymph nodes Australas Radiol 43 148–52 Occurrence Handle1:STN:280:DC%2BD3cvhslWjsw%3D%3D Occurrence Handle10901892
C Voit A Schoengen M Schwurzer-Voit et al. (2002) ArticleTitleThe role of ultrasound in detection and management of regional disease in melanoma patients Semin Oncol 29 353–60 Occurrence Handle12170438
RT Sutton CC Reading JW Charboneau EM James CS Grant ID Hay (1988) ArticleTitleUS-guided biopsy of neck masses in postoperative management of patients with thyroid cancer Radiology 168 769–72 Occurrence Handle1:STN:280:DyaL1czgsVGlsQ%3D%3D Occurrence Handle3043550
CM Balch (1992) ArticleTitleCutaneous melanoma: prognosis and treatment results worldwide Semin Surg Oncol 8 400–14 Occurrence Handle1:STN:280:DyaK3s%2Fmslymtg%3D%3D Occurrence Handle1439450
S Dessureault SJ Soong MI Ross et al. (2001) ArticleTitleImproved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy Ann Surg Oncol 8 766–70 Occurrence Handle1:STN:280:DC%2BD38%2FkvVyguw%3D%3D Occurrence Handle11776489
CR Rossi S Mocellin B Scagnet et al. (2003) ArticleTitleThe role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients J Surg Oncol 83 80–4 Occurrence Handle12772200
C Garbe A Paul H Kohler-Spath et al. (2003) ArticleTitleProspective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy J Clin Oncol 21 520–9 Occurrence Handle12560444
B Kahle J Hoffend J Wacker W Hartschuh (2003) ArticleTitlePreoperative ultrasonographic identification of the sentinel lymph node in patients with malignant melanoma Cancer 97 1947–54 Occurrence Handle12673722
GW Carlson DR Murray RH Lyles CA Staley A Hestley C Cohen (2003) ArticleTitleThe amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol 10 575–81 Occurrence Handle12794026
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Starritt, E.C., Uren, R.F., Scolyer, R.A. et al. Ultrasound Examination of Sentinel Nodes in the Initial Assessment of Patients With Primary Cutaneous Melanoma. Ann Surg Oncol 12, 18–23 (2005). https://doi.org/10.1007/s10434-004-1163-3
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DOI: https://doi.org/10.1007/s10434-004-1163-3