Validity of ultrasound-guided aspiration needle biopsy in the diagnosis of micrometastases in sentinel lymph nodes in patients with cutaneous melanoma
2016
Background/Aim. Cutaneous melanoma is one of the most aggressive solid
cancers, that develops local, regional and distant metastases. The presence
of metastases in lymph nodes is in correlation with Breslow tumor thickness.
According to various researches, in melanoma with more than 4 mm Breslow
thickness, lymph node micrometastases can be found in 60-70% of cases.
Sentinel lymph nodes biopsy is a diagnostic procedure for lymph node
micrometastasis detection, which is necessary for disease staging. In recent
studies, ultrasound-guided fine needle aspiration with cytology (US FNAC) of
the sentinel lymph node was used as less invasive procedure, but is not
accepted as the standard procedure. The goal of this work was to define
sensitivity, specification and precision of the ultrasound-guided fine needle
aspiration method in comparison with standard sentinel lymph node biopsy.
Methods. After obtaining the Ethics Committee’s permission, from 2012 to 2014
a total of 60 patients with cutaneous melanoma were enrolled, and divided
into three groups: group I with thin melanoma, group II with intermediate
thickness melanoma and group III with thick melanoma. The presence of
micrometastases in sentinel regional lymph nodes was analyzed by US FNAC. The
results obtained were compared to sentinel lymph nodes biopsy (SLNB) results.
The golden standard for calculating the specific, sensitive and precise
characteristics of the method of US FNAC of sentinel lymph nodes was
histopathologic lymph node examination of sentinel lymph nodes acquired
through biopsy. Results. Detection rate of US FNAC was 0% in the group I, 5%
in the group II and 30% in the group III. SLNB detection rates were: 10% in
the group I, 15% in the group II, and 45% in the group III. In melanoma
thicker than 4 mm, 15% of the patients were false negative by US FNAC. The
sensitivity of US FNAC for all the patients was 50%: in the group I, 0%; in
the group II, 33.3%; and in the group III, 66.6%. The method specificity for
all examined patients was 100% and accuracy 88%: group I, 90%; group II, 90%;
group III, 85%. The FNAC and SLNB micrometastasis detection rate was
significantly higher in melanoma with Breslow thickness > 4 mm (group 3) in
comparison to thin and intermediate thickness tumors. Conclusion. The method
of ultrasound-guided fine needle aspiration of sentinel lymph nodes,
according to its sensitivity, has a place in the diagnostics of
micrometastasis in regional lymph nodes only in thick melanoma, but not in
thin and intermediary thickness melanoma. The results must be confirmed in a
larger number of patients. If this observation could be confirmed, it would
rationalize treatment of patients with thick melanoma, decrease the number of
operations and shorten the time to make the diagnosis.
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