Department of Dermatology and Allergology, Center of Integrated Oncology CIO Cologne-Bonn, University of Bonn, Bonn, Germany.
Dermatology. 2013;226(1):81-90. doi: 10.1159/000346942. Epub 2013 Mar 15.
Real-time tissue elastography is a new, noninvasive method in ultrasonography, differentiating tissues according to their stiffness. Earlier studies have highlighted this technique as a useful diagnostic tool for the detection of noncutaneous malignancies like breast, prostate and thyroid cancer based on the principle that tumor cells present a higher stiffness compared to the adjacent normal tissue.
The purpose of our study was to investigate the value of real-time tissue elastography for the differentiation of benign and metastatic peripheral lymph nodes (LN) in patients with cutaneous melanoma by comparing this technique with conventional B-mode sonography combined with power Doppler sonography (PDS).
In this prospective study, 36 melanoma patients (23 females and 13 males, mean age 62.7 ± 11.1 years) undergoing LN excision at the Department of Dermatology and Allergy, University of Bonn, were included between July 2011 and July 2012. Real-time tissue elastography was planned prior to surgery and histopathological examination. Elasticity images had been qualitatively scored for the proportion of stiff areas from pattern 1-5 (soft to stiff) on the basis of a newly defined system for LNs.
A total of 42 LNs have been removed in 36 patients. Of these 42 LNs, 21 carried melanoma cells and 21 were benign LNs. Significant differences in elastographic patterns were found between metastatic and nonmetastatic LNs. In real-time tissue elastography, 19 (90.5%) of 21 metastatic LNs showed a pattern of 3, 4 or 5. Of all benign LNs, 76.2% had a pattern of 1 or 2 in their elastogram. Sensitivity and specificity of B-mode sonography combined with PDS were 80.9 and 76.2%, respectively, 90.5 and 76.2% for elastography and 95.2 and 76.2% for the combined evaluation.
An elastography pattern ≥3 was identified as an independent significant factor, predicting a metastatic LN involvement. The combination of elastography with conventional B-mode sonography has the potential to further improve the differentiation between benign and metastatic peripheral LNs in melanoma patients.
实时组织弹性成像（real-time tissue elastography）是超声领域的一种新的非侵入性方法，根据组织的硬度对组织进行区分。早期的研究强调，该技术是一种有用的诊断工具，可用于检测非皮肤恶性肿瘤，如乳腺癌、前列腺癌和甲状腺癌，其原理是肿瘤细胞比相邻的正常组织具有更高的硬度。
我们的研究旨在通过将实时组织弹性成像与常规 B 型超声（B-mode sonography）联合彩色多普勒超声（power Doppler sonography，PDS）对比，探讨该技术在区分皮肤黑色素瘤患者良性和转移性外周淋巴结（peripheral lymph nodes，LN）中的价值。
在这项前瞻性研究中，2011 年 7 月至 2012 年 7 月，36 例黑色素瘤患者（23 名女性和 13 名男性，平均年龄 62.7 ± 11.1 岁）在波恩大学皮肤科和过敏科接受 LN 切除术，纳入本研究。在手术和组织病理学检查前计划进行实时组织弹性成像。根据新定义的 LN 系统，对弹性图像中僵硬区域的比例进行定性评分，从模式 1-5（柔软至僵硬）进行评分。
在 36 例患者中共切除 42 枚 LN。其中 21 枚 LN 携带黑色素瘤细胞，21 枚为良性 LN。转移性和非转移性 LN 的弹性成像模式存在显著差异。在实时组织弹性成像中，21 枚转移性 LN 中有 19 枚（90.5%）显示为 3、4 或 5 型。在所有良性 LN 中，76.2%的弹性图像模式为 1 或 2。B 型超声联合 PDS 的敏感性和特异性分别为 80.9%和 76.2%，弹性成像分别为 90.5%和 76.2%，联合评估分别为 95.2%和 76.2%。
弹性成像模式≥3 被确定为独立的显著因素，可预测 LN 转移。将弹性成像与常规 B 型超声联合应用，有可能进一步提高黑色素瘤患者良性和转移性外周 LN 的鉴别能力。
