Saiag Philippe, Bernard Marion, Beauchet Alain, Bafounta Marie-Lise, Bourgault-Villada Isabelle, Chagnon Sophie
Service de Dermatologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, Boulogne, France.
Arch Dermatol. 2005 Feb;141(2):183-9. doi: 10.1001/archderm.141.2.183.
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.
Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation.
Dermatology and radiology departments of a university hospital.
A total of 160 new consecutive patients with stage I to stage III melanoma.
Experienced operators independently performed 391 paired palpation and ultrasonographic examinations.
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.
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.
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.
我们的目的是（1）比较超声检查和触诊在黑色素瘤患者初始分期和随访期间检测淋巴结转移的各自能力，以及（2）我们认为首次评估在皮肤或黏膜黑色素瘤病例中应使用哪些超声标准来定义转移。
前瞻性单中心研究。淋巴结转移通过组织病理学评估确诊。
大学医院的皮肤科和放射科。
总共160例新的连续的I期至III期黑色素瘤患者。
经验丰富的操作人员独立进行了391次配对的触诊和超声检查。
触诊时发现的质地硬且肿大的淋巴结被视为转移。在超声检查中，圆形或椭圆形低回声淋巴结且无高回声门部被视为转移（严格标准）。具有2种或更少这些特征以及其他已发表的转移征象（即结内结节状低回声灶和淋巴结边缘不规则）的淋巴结被视为可疑。
在6年的研究期间，33例患者发生了淋巴结转移。对于触诊和使用严格标准的超声检查，敏感性分别为41.5%（95%置信区间[95%CI]，29.6 - 53.5）和76.9%（95%CI，66.7% - 87.2%）（P <.001），特异性分别为95.7%（95%CI，93.5% - 9
