van Rijk Maartje C, Teertstra H Jelle, Peterse Johannes L, Nieweg Omgo E, Olmos Renato A Valdés, Hoefnagel Cornelis A, Kroon Bin B R
Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
Ann Surg Oncol. 2006 Nov;13(11):1511-6. doi: 10.1245/s10434-006-9106-9. Epub 2006 Sep 29.
Ultrasonography with fine-needle aspiration cytology (FNAC) has proven to be a valuable diagnostic tool in the preoperative workup of patients with breast cancer or penile cancer eligible for sentinel lymph node biopsy. The aim of this study was to evaluate the use of this technique in the initial assessment of patients with primary cutaneous melanoma.
A total of 107 patients with cutaneous melanoma eligible for sentinel node biopsy with clinically negative nodes were studied prospectively. Patients underwent ultrasonography of potentially involved basins and FNAC in case of a suspicious lymph node. The sentinel node procedure was omitted in patients with tumour-positive lymph nodes in lieu of lymph node dissection.
Ultrasonography with FNAC correctly identified disease preoperatively in two of the 107 patients (2%). Thirteen of the 22 patients (59%) with a suspicious node on ultrasonographic imaging but a tumour-negative fine-needle aspirate were shown to have involved nodes. Of the 85 patients with ultrasonographically normal nodes, 25 (29%) were shown to have metastases. Of the total of 43 involved basins, 16 contained metastases > 2 mm and 25 < or = 2 mm.
In our hands, the sensitivity and specificity of preoperative ultrasonography to detect lymph node involvement in patients with melanoma are 34% and 87%, respectively. In combination with FNAC, this is 4.7% and 100%, respectively. This yield is insufficient for this technique to be used as a routine diagnostic tool in the selection of patients eligible for sentinel node biopsy.
超声检查结合细针穿刺细胞学检查（FNAC）已被证明是对适合前哨淋巴结活检的乳腺癌或阴茎癌患者进行术前检查的一种有价值的诊断工具。本研究的目的是评估该技术在原发性皮肤黑色素瘤患者初始评估中的应用。
前瞻性研究了总共107例适合前哨淋巴结活检且临床淋巴结阴性的皮肤黑色素瘤患者。对可能受累的区域进行超声检查，若发现可疑淋巴结则进行FNAC。对于淋巴结肿瘤阳性的患者，省略前哨淋巴结手术，取而代之的是淋巴结清扫术。
超声检查结合FNAC在107例患者中的2例（2%）术前正确识别出疾病。在超声成像显示可疑但细针抽吸为肿瘤阴性的22例患者中，有13例（59%）被证实有受累淋巴结。在超声检查淋巴结正常的85例患者中，有25例（29%）被证实有转移。在总共43个受累区域中，16个区域的转移灶>2mm，25个区域的转移灶≤2mm。
在我们的研究中，术前超声检查检测黑色素瘤患者淋巴结受累的敏感性和特异性分别为34%和87%。与FNAC联合使用时，敏感性和特异性分别为4.7%和100%。该结果不足以使该技术作为选择适合前哨淋巴结活检患者的常规诊断工具。
