Oude Ophuis C M C, Verhoef C, Grünhagen D J, Siegel P, Schoengen A, Röwert-Huber J, Eggermont A M M, Voit C A, van Akkooi A C J
Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075EA Rotterdam, The Netherlands.
Department of Dermatology, Charité-University of Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Eur J Surg Oncol. 2017 Aug;43(8):1509-1516. doi: 10.1016/j.ejso.2017.02.009. Epub 2017 Feb 21.
US-FNAC is a common diagnostic tool in the work-up of many cancers. Results in melanoma were initially poor (sensitivity 20-40%). Introduction of the Berlin Morphology criteria has shown potential improvement up to 65-80% in selected patients.
This cohort study evaluates the long-term survival outcome of melanoma patients undergoing Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) prior to sentinel node biopsy (SNB) or direct lymphadenectomy.
Between 2001 and 2010 over 1000 consecutive melanoma patients prospectively underwent targeted US-FNAC prior to SNB. The Berlin US morphology criteria: peripheral perfusion (PP), loss of central echoes (LCE) and balloon shape (BS) were registered. FNAC was performed if any factor was present. All patients underwent SNB or lymphadenectomy in case of positive FNAC.
Median follow-up was 61 months (IQR 40-95). SN positivity rate was 21%. Survival analyses demonstrated that patients with positive US-FNAC had poor survival. After adjustment for SN status and other known prognostic features, patients with positive US-FNAC (hazard ratio (HR) 1.80, 95% CI 1.10-2.96) had worse survival than patients with normal US (reference). Patients with suspicious US and negative FNAC (HR 1.13, 95% CI 0.71-1.78) had survival comparable to patients with normal US.
The long-term US-FNAC results support this step-wise approach to melanoma patients. Patients with positive US-FNAC have a poor survival and can be spared a SNB. Patients with suspicious US and negative FNAC should undergo SNB to detect microscopic occult disease. Completely US-FNAC negative patients might only require follow-up and no SN staging at all.
超声引导下细针穿刺抽吸活检（US-FNAC）是许多癌症检查中的常用诊断工具。其在黑色素瘤诊断中的最初结果不佳（敏感性为20%-40%）。引入柏林形态学标准后，部分患者的诊断潜力提高至65%-80%。
本队列研究评估了在进行前哨淋巴结活检（SNB）或直接淋巴结清扫术前接受超声（US）引导下细针穿刺细胞学检查（FNAC）的黑色素瘤患者的长期生存结局。
2001年至2010年间，超过1000例连续的黑色素瘤患者在SNB前接受了靶向US-FNAC检查。记录柏林超声形态学标准：外周灌注（PP）、中央回声缺失（LCE）和气球样形态（BS）。若存在任何一项因素，则进行FNAC检查。所有患者在FNAC结果为阳性时接受SNB或淋巴结清扫术。
中位随访时间为61个月（四分位间距40-95个月）。前哨淋巴结阳性率为21%。生存分析表明，US-FNAC结果为阳性的患者生存情况较差。在对前哨淋巴结状态和其他已知预后特征进行校正后，US-FNAC结果为阳性的患者（风险比（HR）1.80，95%置信区间1.10-2.96）的生存情况比US结果正常的患者（参照组）更差。US结果可疑且FNAC结果为阴性的患者（HR 1.1...，95%置信区间0.71-1.78）的生存情况与US结果正常的患者相当。
长期的US-FNAC结果支持对黑色素瘤患者采用这种逐步检查的方法。US-FNAC结果为阳性的患者生存情况较差，可以不进行前哨淋巴结活检。US结果可疑且FNAC结果为阴性的患者应进行前哨淋巴结活检以检测微小隐匿性疾病。US-FNAC结果完全为阴性的患者可能仅需进行随访，无需进行前哨淋巴结分期。 （注：原文中“HR 1.13, 95% CI 0.71-1.78”处“1.1...”应为“1.13”，译文已修正）
