Doubrovsky Anna, Scolyer Richard A, Murali Rajmohan, McKenzie Paul R, Watson Geoffrey F, Lee C Soon, McLeod Duncan J, McCarthy William H, Uren Roger F, Stretch Jonathan R, Saw Robyn P, Thompson John F
Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
Ann Surg Oncol. 2008 Jan;15(1):323-32. doi: 10.1245/s10434-006-9341-0. Epub 2007 Nov 8.
The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated.
A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up.
FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results.
FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma.
使用细针穿刺活检（FNB）诊断转移性黑色素瘤可实现转移灶的早期切除和治疗，减少不必要手术的频率，并有助于对参加辅助治疗临床试验的患者进行分期。在本研究中，对FNB诊断转移性黑色素瘤的准确性进行了调查。
对1416例已知或疑似患有转移性黑色素瘤的患者连续进行了2204次FNB，进行了一项回顾性队列研究。这些FNB中近四分之三（1582例）通过手术切除后的组织病理学诊断或临床随访得到证实。
发现FNB诊断转移性黑色素瘤的总体敏感性为92.1%，特异性为99.2%，共发现69例假阴性和5例假阳性结果。发现该操作的敏感性受六个因素影响。使用免疫染色、由报告过>500例病例的细胞病理学家报告标本、位于皮肤和皮下组织的病变以及原发性黑色素瘤溃疡的患者是与检测敏感性显著提高相关的因素。然而，在腋窝淋巴结肿块中进行的FNB以及需要多次进针才能获取样本的FNB更有可能导致假阴性结果。
FNB是一种快速、准确且临床上有用的技术，可用于评估疑似转移性黑色素瘤患者的疾病状态。
