Melanoma Institute Australia and Sydney Melanoma Unit, Royal Prince Alfred and Mater Hospitals, Sydney, New South Wales, Australia
J Clin Oncol. 2009 Nov 20;27(33):5614-9. doi: 10.1200/JCO.2008.21.4882. Epub 2009 Sep 28.
To reassess traditional ultrasound descriptors of sentinel lymph node (SLN) metastases, to determine the minimum cross-sectional area (CSA) of an SLN metastasis detectable by ultrasound (US), and to establish whether targeted, high-resolution US of SLNs identified by lymphoscintigraphy before initial melanoma surgery can be used as a substitute for excisional SLN biopsy.
US was performed on SLNs identified in 871 lymph node fields in 716 patients. SLN biopsy was performed within 24 hours of lymphoscintigraphy and US examination. The CSA of each SLN metastatic deposit was determined sonographically and histologically.
The sensitivity of targeted US in the detection of positive SLNs was 24.3% (95% CI, 19.5% to 28.7%), and the specificity was 96.8% (95% CI, 95.9% to 97.7%). The sensitivity was highest for neck SLNs (45.8%) and improved with greater Breslow thickness. The median histologic CSA of the SLN metastatic deposits was 0.39 mm(2) (12.75 mm(2) for US true-positive results and 0.22 mm(2) for US false-negative results). True-positive, US-detected SLNs had significantly greater CSAs (t test P < .001) than undetected SLN metastases and were more likely to be spherical in cross-section. More than two sonographic descriptors of SLN metastases or rounding of the node alone were factors highly suggestive of a melanoma deposit.
US is not an appropriate substitute for SLN biopsy, but it is of value in preoperative SLN assessment and postoperative monitoring.
重新评估前哨淋巴结（SLN）转移的传统超声描述，确定超声（US）可检测到的 SLN 转移的最小截面积（CSA），并确定术前淋巴闪烁显像术识别的 SLN 行靶向高分辨率 US 是否可替代切除性 SLN 活检。
对 716 例患者的 871 个淋巴结区域中的 SLN 进行 US 检查。SLN 活检在淋巴闪烁显像术和 US 检查后 24 小时内进行。每个 SLN 转移性沉积物的 CSA 通过超声和组织学确定。
靶向 US 检测阳性 SLN 的敏感性为 24.3%（95%CI，19.5%至 28.7%），特异性为 96.8%（95%CI，95.9%至 97.7%）。颈部 SLN 的敏感性最高（45.8%），且随着 Breslow 厚度的增加而提高。SLN 转移性沉积物的中位组织学 CSA 为 0.39mm²（US 真阳性结果为 12.75mm²，US 假阴性结果为 0.22mm²）。真阳性、US 检测的 SLN 具有显著更大的 CSA（t 检验 P<.001），而未检测到的 SLN 转移和更有可能在横截面上呈球形。多于两个 SLN 转移的超声描述或节点单独变圆是高度提示黑色素瘤沉积的因素。
US 不是 SLN 活检的合适替代方法，但在术前 SLN 评估和术后监测中具有价值。
