The contribution of high-resolution ultrasonography in preoperatively detecting sentinel-node metastases in melanoma patients

• DOI: 10.1097/cmr.0b013e3282c3a65a
• Publication Date: 2007-07-11T08:30:15Z
• Authors: Claire Sibon; Sophie Chagnon; Arnold Tchakérian; Marie-Lise Bafounta; Christine Longvert; Thierry Clerici; Ute Zimmermann; Philippe Saiag
• Keywords: Adult; Aged, 80 and over; Male; Skin Neoplasms; Adolescent; Sentinel Lymph Node Biopsy; Middle Aged; Sensitivity and Specificity; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Lymphatic Metastasis; Humans; False Positive Reactions; Female; Melanoma; Aged; Ultrasonography

To evaluate the ability of high-resolution ultrasonography (hrUS) to detect sentinel-node (SN) melanoma metastases preoperatively before sentinel-node biopsy (SNB), to define hrUS resolution, and to evaluate which US criteria should be used. During a 6.5-year period, 131 consecutive patients with 132 >or=1-mm thick or ulcerated cutaneous melanomas, who were followed up at a single center, were enrolled. All patients underwent preoperative regional lymph-node hrUS and SNB. We used the recently evaluated ultrasonographic stringent and nonstringent hrUS criteria to detect SN metastases. Sizes of the SN metastatic deposits were measured under light microscopy. Thirty-five (27%) patients had a positive SNB. HrUS identified only three positive SNs as being metastatic. Sensitivity and specificity using stringent criteria were 8.8% [95% confidence interval (CI, 2.3-24.8%) and 95.9% (95% CI, 89.3-98.7%)], respectively. Positive-predictive value was 42.9% (95% CI, 11.9-79.9%). The nonstringent criteria provided four additional true-positive results, but lowered specificity (89.8%; 95% CI, 81.6-94.7%) with no significant improvement in sensitivity (20.6%; 95% CI, 9.3-38.4%). Positive-predictive value using nonstringent criteria was 41.2% (95% CI, 19.3-66.4%). HrUS failed to detect all metastatic deposits <5 mm in diameter. HrUS assessment of early-stage melanomas cannot replace surgical SNB. Owing to its low positive-predictive value, hrUS was unable to identify patients who would have to proceed directly to completion lymphadenectomy.