Fernández Canedo I, de Troya Martín M, Fúnez Liébana R, Rivas Ruiz F, Blanco Eguren G, Blázquez Sánchez N
Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain.
Actas Dermosifiliogr. 2013 Apr;104(3):227-31. doi: 10.1016/j.ad.2012.06.007. Epub 2012 Aug 28.
Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment.
a) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness.
Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed.
The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (P>.05). The sensitivity of ultrasound for the diagnosis of MM over 1mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively.
Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.
肿瘤厚度在皮肤恶性黑色素瘤（MM）的治疗中至关重要：这一变量不仅影响预后，也是规划手术切缘和选择前哨淋巴结活检候选者的关键因素。Breslow深度是厚度的标准组织学测量方法，但技术进步提供了如皮肤超声等成像技术，其有可能评估肿瘤厚度并促使及时开始确定性治疗。
a）评估超声评估MM肿瘤厚度的效用，以及b）分析影响超声厚度评估的组织学变量。
对连续79例原发性皮肤MM进行回顾性研究，术前通过15兆赫超声评估肿瘤厚度。我们从组织学报告中收集数据，研究Breslow深度以及溃疡、消退、炎性浸润和相关痣的存在情况。计算相关系数以评估Breslow深度与超声评估厚度之间的关联强度。我们还计算了超声测量在诊断厚度超过1毫米的MM中的敏感性、特异性、阳性和阴性预测值。还分析了组织学变量与超声对厚度高估之间的关联。
所研究的79例原发性MM的平均（标准差）Breslow深度为0.8（1.4）毫米。Breslow深度与超声厚度评估之间存在中度相关性和一致性（Pearson相关系数为0.678；组内相关系数为0.78）。超声高估厚度的趋势与中度至重度浸润和相关痣的存在无显著相关性（P>0.05）。超声诊断厚度超过1毫米的MM的敏感性为82%；特异性为80%，阳性和阴性预测值分别为54%和94%。
超声成像能相当准确地识别薄型MM，可用于规划足够的手术切缘；然而，其在诊断厚型MM方面的效用存在局限性。需要进一步研究以确认某些组织学特征，如中度至重度炎性浸润或相关痣的存在是否会导致超声高估厚度，从而限制这种成像技术在MM治疗中的临床效用。
