Department of Dermatology and Allergology, Center of Integrated Oncology Cologne Bonn, University of Bonn, Bonn, Germany.
Dermatology. 2011;222(2):180-8. doi: 10.1159/000325462. Epub 2011 Apr 5.
Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with cutaneous melanoma. Disadvantages of the SLNB procedure are the overall costs and potential side effects of the operation [J Dtsch Dermatol Ges 2009;7:318-327; J Am Dermatol 2010;62:737-748].
The purpose of our study was to evaluate whether high-resolution ultrasound combined with power Doppler sonography (PDS) is an appropriate tool for preoperative identification and characterization of sentinel lymph nodes (SLNs) in patients with cutaneous melanoma.
In a prospective study eighty-one consecutive patients with cutaneous melanoma (33 females and 48 males) in whom dissection of SLNs was indicated underwent ultrasound examinations before and after the preoperative lymphoscintigraphy.
A total of 170 SLNs (mean 2.1 per patient) were removed and examined by histopathology. High resolution ultrasound combined with PDS correctly identified 2 of 9 positive SLNs. The sensitivity, specificity, positive predictive value, and negative predictive values of ultrasound were 22.2% (95% confidence interval (CI) = 2.8-60.0), 100% (95% CI = 97.7-100.0), 100.0% (95% CI = 15.8-100.0), and 95.8% (95% CI = 91.6-98.3), respectively.
Although high-resolution ultrasound combined with PDS cannot substitute SLNB, this technique offers earlier diagnosis of lymph node involvement in a small subgroup of patients (with subcapsular location of metastases), and introduces the possibility to exclude those patients from SLN procedure and directly prepare them for complete lymph node dissection (CLND).
前哨淋巴结活检（SLNB）是一种广泛接受的方法，可准确分期皮肤黑素瘤患者。该手术的缺点是总体成本以及手术的潜在副作用[J Dtsch Dermatol Ges 2009;7:318-327; J Am Dermatol 2010;62:737-748]。
我们的研究目的是评估高分辨率超声联合功率多普勒超声（PDS）是否是一种用于术前识别和特征化皮肤黑素瘤患者前哨淋巴结（SLN）的合适工具。
在一项前瞻性研究中，81 例连续皮肤黑素瘤患者（33 名女性和 48 名男性），其中有指征进行 SLN 解剖，在术前淋巴闪烁显像前后进行超声检查。
共切除和病理检查了 170 个 SLN（平均每个患者 2.1 个）。高分辨率超声联合 PDS 正确识别了 9 个阳性 SLN 中的 2 个。超声的敏感性、特异性、阳性预测值和阴性预测值分别为 22.2%（95%置信区间（CI）=2.8-60.0）、100%（95% CI=97.7-100.0）、100.0%（95% CI=15.8-100.0）和 95.8%（95% CI=91.6-98.3）。
尽管高分辨率超声联合 PDS 不能替代 SLNB，但该技术为一小部分患者（有包膜下转移的患者）提供了更早诊断淋巴结受累的可能，并使这些患者有可能从 SLN 手术中排除，并直接为他们准备完全淋巴结清扫术（CLND）。
