使用简单诊断标准的超声检查与触诊在检测黑色素瘤区域淋巴结转移中的比较。

Ultrasonography using simple diagnostic criteria vs palpation for the detection of regional lymph node metastases of melanoma.

作者信息

Saiag Philippe, Bernard Marion, Beauchet Alain, Bafounta Marie-Lise, Bourgault-Villada Isabelle, Chagnon Sophie

机构信息

Service de Dermatologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, Boulogne, France.

出版信息

Arch Dermatol. 2005 Feb;141(2):183-9. doi: 10.1001/archderm.141.2.183.

DOI:10.1001/archderm.141.2.183

PMID:15724014

Abstract

OBJECTIVES

Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma.

DESIGN

Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation.

SETTING

Dermatology and radiology departments of a university hospital.

PATIENTS

A total of 160 new consecutive patients with stage I to stage III melanoma.

INTERVENTION

Experienced operators independently performed 391 paired palpation and ultrasonographic examinations.

MAIN OUTCOME MEASURES

Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious.

RESULTS

Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval [95% CI], 29.6-53.5) and 76.9% (95% CI, 66.7%-87.2%) (P<.001) and specificity was 95.7% (95% CI, 93.5%-97.9%) and 98.4% (95% CI, 97.1%-99.8%) (P<.05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% [95% CI, 82.5-89.9]) (P<.05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings.

CONCLUSION

Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.

摘要