Bossi M C, Sanvito S, Lovati E, De Fiori E, Testori A, Bellomi M
Divisione di Radiodiagnostica, Istituto Europeo di Oncologia, Milan, Italy.
Radiol Med. 2001 Nov-Dec;102(5-6):357-62.
The aims of the present work are to assess the diagnostic accuracy of high resolution color Doppler ultrasound (US) of the sentinel node (SN) in patients with cutaneous melanoma skin at stage I. The US findings of nodal involvement could spare the patient a surgical step (selective lymphaderectomy) allowing them to undergo radical lymphadenectomy directly.
From November 1998 to November 2000 94 patients (mean age 52.7 years) underwent lymphoscintigraphy in order to mark the SN site on their skin. An US scan (112 lymphatic basins) was performed within 24 hours with a 10-13 MHz electronic linear probe with color-power-Doppler (Esaote AU5 Idea Scanner, Genoa, Italy). The sonographic features we analysed were: shape (roundness index), hilum displacement, intranodal heterogenicity, eccentric cortical thickness, extranodal invasion, vessel irregularity.
26 nodes showed US findings consistent with malignant involvement, 86 were negative. All the nodes were surgically removed and controlled by histology. Sensitivity and specificity of US scanning were 89.4% and 90.3%, the positive and negative predictive values 65.3% and 97.6%, respectively. US correctly identified the involved SN in 15,1% cases, so that 17 patients could have avoided the selective lymphadenectomy
Preoperative lymphoscintigraphy and high-resolution color-Doppler US scanning constitute a useful diagnostic tool in identifying the metastatic SN, with a low margin of error. False negatives were technically induced, even using the more recent scanners, by the low US probe resolution, unable to recognise metastatic microdeposits. The two most reliable parameters in identifying involved lymphnodes were the roundness index and the absence of hilar echo. The advent of technologically more advanced probes should allow better spatial resolution and assessment of lymph node vascularization, enabling diagnosis of metastasis measuring less than 2 mm in diameter.
本研究旨在评估高分辨率彩色多普勒超声（US）对I期皮肤黑色素瘤患者前哨淋巴结（SN）的诊断准确性。淋巴结受累的超声检查结果可使患者避免手术步骤（选择性淋巴结清扫术），从而直接接受根治性淋巴结清扫术。
1998年11月至2000年11月，94例患者（平均年龄52.7岁）接受了淋巴闪烁显像，以在其皮肤上标记SN部位。在24小时内使用配备彩色能量多普勒的10 - 13MHz电子线性探头（意大利热那亚百胜AU5 Idea扫描仪）进行超声扫描（112个淋巴区域）。我们分析的超声特征包括：形状（圆度指数）、门部移位、结内异质性、偏心皮质厚度、结外侵犯、血管不规则性。
26个淋巴结显示超声检查结果与恶性受累一致，86个为阴性。所有淋巴结均通过手术切除并进行组织学检查。超声扫描的敏感性和特异性分别为89.4%和90.3%，阳性和阴性预测值分别为65.3%和97.6%。超声在15.1%的病例中正确识别出受累的前哨淋巴结，因此17例患者可避免选择性淋巴结清扫术。
术前淋巴闪烁显像和高分辨率彩色多普勒超声扫描是识别转移性前哨淋巴结的有用诊断工具，误差率较低。即使使用更新的扫描仪，由于超声探头分辨率低，无法识别转移性微沉积物，技术上仍会导致假阴性。识别受累淋巴结的两个最可靠参数是圆度指数和无门部回声。技术更先进的探头的出现应能实现更好的空间分辨率和淋巴结血管化评估，从而能够诊断直径小于2mm的转移灶。
