Johnson T M, Fader D J, Chang A E, Yahanda A, Smith J W, Hamlet K R, Sondak V K
Department of Dermatology, University of Michigan Medical Center, Ann Arbor 48109-0314, USA.
Ann Surg Oncol. 1997 Jul-Aug;4(5):396-402. doi: 10.1007/BF02305552.
This study addresses the yield and clinical impact of computed tomography (CT) imaging in otherwise asymptomatic patients with stage III melanoma metastatic to the regional nodes.
The database from the University of Michigan Mutlidisciplinary Melanoma Clinic was reviewed and identified 127 asymptomatic patients with stage III melanoma (regional nodal disease) who received CT scans of the head, chest, abdomen, and/or pelvis. Scans were confirmed as true positive, false positive, and normal.
Four hundred twenty-six head and body CT scans were performed at the time of presentation of stage III disease. Twenty patients had a true-positive CT scan revealing unsuspected metastases. Fifteen patients had abnormal CT scans subsequently shown to be a benign process or second malignancy. The incidence of true-positive CT scans was not different between the groups of patients who had clinically apparent versus occult nodal disease. There was a significantly higher incidence of abdominal and pelvic metastatic sites identified by CT scan in patients with inguinal nodal disease compared with axillary or head and neck node-positive patients.
The yield of detection of unsuspected metastases by CT scans in asymptomatic patients with stage III melanoma was not insignificant. Because patients with resected stage III disease are recommended to have adjuvant interferon-alpha for 1 year, CT staging plays an important role in identifying appropriate candidates for treatment. The toxicity of interferon-alpha therapy is not insignificant. The value of routine CT in asymptomatic patients with nodal metastasis deserves further prospective study.
本研究探讨计算机断层扫描（CT）成像对于区域淋巴结转移的无症状III期黑色素瘤患者的检出率及临床影响。
回顾了密歇根大学多学科黑色素瘤诊所的数据库，确定了127例无症状的III期黑色素瘤（区域淋巴结疾病）患者，这些患者接受了头部、胸部、腹部和/或骨盆的CT扫描。扫描结果被确认为真阳性、假阳性和正常。
在III期疾病确诊时共进行了426次头部和身体CT扫描。20例患者的CT扫描结果为真阳性，显示出意外转移。15例患者的CT扫描异常，随后被证明是良性病变或第二原发性恶性肿瘤。在临床明显淋巴结疾病与隐匿性淋巴结疾病的患者组中，真阳性CT扫描的发生率没有差异。与腋窝或头颈部淋巴结阳性患者相比，腹股沟淋巴结疾病患者通过CT扫描发现的腹部和盆腔转移部位的发生率显著更高。
CT扫描在无症状的III期黑色素瘤患者中检测意外转移的检出率并非微不足道。由于建议对切除的III期疾病患者进行1年的辅助α干扰素治疗，CT分期在确定合适的治疗候选者方面起着重要作用。α干扰素治疗的毒性并非微不足道。对于无症状的淋巴结转移患者进行常规CT检查的价值值得进一步进行前瞻性研究。
