Olmedo D, Brotons-Seguí M, Del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E
Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
Facultad de Medicina, Universidad Católica de Valencia, Valencia, España.
Actas Dermosifiliogr. 2017 Dec;108(10):931-938. doi: 10.1016/j.ad.2017.06.002. Epub 2017 Aug 8.
Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB.
We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy.
Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00).
Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.
局部区域淋巴结超声通常未被纳入前哨淋巴结活检（SLNB）之前分期过程的指南中。本研究的目的是对SLNB之前的淋巴结超声进行临床和经济分析。
我们对2004年至2015年间384例临床I-II期原发性黑色素瘤患者进行了回顾性研究，这些患者在SLNB之前接受了局部区域淋巴结超声检查（有或无超声引导下活检）。我们评估了该策略的可靠性和成本效益。
局部区域淋巴结超声检查使23例患者（6%）避免了SLNB。超声检测临床未触及的转移性淋巴结的敏感性为46%，特异性为76%。假阴性在60岁以上患者和厚度小于2mm的肿瘤中更为常见。使用SLNB以及超声引导下活检的超声进行分期过程使单价增加了16.30欧元。我们的成本效益分析确定，超声和SLNB的分期方案是主要策略，其成本效益比低于仅进行SLNB的替代方案（8,095.24欧元对28,605.00欧元）。
在SLNB之前，超声引导下活检用于黑色素瘤诊断分期是一种有用且具有成本效益的工具。该程序不能替代SLNB，但确实能在相当一部分患者中避免进行SLNB。
