Ternov Niels K, Lambine Trine-Lise, Wagenblast Anne L H, Clasen-Linde Erik, Oturai Peter S, Klyver Helle, Nielsen Kristina R, Nielsen Michael B, Drzewiecki Krzysztof T, Chakera Annette H
Department of Plastic Surgery, Herlev University Hospital.
Departments of Radiology.
Melanoma Res. 2018 Aug;28(4):319-325. doi: 10.1097/CMR.0000000000000448.
Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is used to evaluate the involvement of lymph nodes in various malignant diseases. Its value in detecting sentinel lymph node (SN) metastasis preoperatively in melanoma patients is controversial and is the subject of this study. In this prospective validation study, 91 consecutive patients with melanoma clinical stage I (n=64) and II (n=27) were examined with US-FNAC before SN biopsy from 2012 to 2014 at a tertiary center. All patients underwent lymphoscintigraphy before the US-FNAC. Lymph nodes that showed any of the Berlin morphologic criteria on ultrasonography were examined using FNAC. The median Breslow thickness of the melanomas was 1.22 mm (range: 0.47-11.5 mm). Twenty-two percent of the patients had metastases in their SNs, 90% of which were smaller than 2 mm in largest diameter. The percentages of metastases with a size more than 1 mm were 50 and 29%, respectively, in the true-positive and false-negative US groups. The sensitivity, specificity, positive predictive value, and negative predictive value for overall US examination were 30, 81, 24, and 83%, respectively. None of the FNACs contained conclusive malignant cells. The specificity of the FNAC was 76%. Our results show that US-FNAC was not a useful diagnostic tool in our setting as it did not add significantly to the staging and management of patients with mainly thin cutaneous melanomas, perhaps because of the often small size of the SN metastases. It may be useful in the early diagnosis of lymph node metastases in a subgroup of melanoma patients with larger metastases.
超声引导下细针穿刺细胞学检查（US-FNAC）用于评估各种恶性疾病中淋巴结的受累情况。其在术前检测黑色素瘤患者前哨淋巴结（SN）转移中的价值存在争议，也是本研究的主题。在这项前瞻性验证研究中，2012年至2014年在一家三级中心对91例连续的临床I期（n = 64）和II期（n = 27）黑色素瘤患者在进行SN活检前采用US-FNAC进行检查。所有患者在进行US-FNAC前均接受了淋巴闪烁显像。对超声检查显示有任何柏林形态学标准的淋巴结进行细针穿刺活检。黑色素瘤的中位Breslow厚度为1.22毫米（范围：0.47 - 11.5毫米）。22%的患者SN有转移，其中90%最大直径小于2毫米。在US真阳性组和假阴性组中，直径大于1毫米的转移灶百分比分别为50%和29%。总体US检查的敏感性、特异性、阳性预测值和阴性预测值分别为30%、81%、24%和83%。所有细针穿刺活检均未发现确诊的恶性细胞。细针穿刺活检的特异性为76%。我们的结果表明，在我们的研究环境中，US-FNAC不是一种有用的诊断工具，因为它对主要为薄皮黑色素瘤患者的分期和管理没有显著帮助，可能是因为SN转移灶通常较小。它可能对黑色素瘤转移灶较大的亚组患者的淋巴结转移早期诊断有用。
