Christiane A Voit1, Saskia L M Gooskens2, Petra Siegel3, Gregor Schaefer3, Alfred Schoengen4, Joachim Röwert3, Alexander C J van Akkooi2, Alexander M M Eggermont5. 1. Department of Dermatology, Charité, Humboldt University of Berlin, Berlin, Germany; European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group (MG), Brussels, Belgium. Electronic address: christiane.voit@t-online.de. 2. Department of Surgical Oncology, Erasmus University Medical Center - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands; European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group (MG), Brussels, Belgium. 3. Department of Dermatology, Charité, Humboldt University of Berlin, Berlin, Germany. 4. Department of Hematology and Oncology, Armed Forces Hospital, Ulm, Germany. 5. Institut de Cancérologie Gustav Roussy, Paris-Sud/Villejuif, France; European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group (MG), Brussels, Belgium.
Abstract
BACKGROUND: Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanoma patients is controversial and subject of this study. METHODS: Between 2001 and 2010 over 1000 stage I/II consecutive melanoma patients prospectively underwent US-FNAC prior to SN biopsy. All patients underwent lymphoscintigraphy prior to US-FNAC. The Berlin US morphology criteria: Peripheral perfusion (PP), loss of central echoes (LCE) and balloon shaped (BS) were registered. FNAC was performed in case of presence of any of these factors. SN tumour burden was measured according to the Rotterdam criteria. All patients underwent SN or lymph node dissection (LND) in case of positive FNAC. FINDINGS: Mean/median Breslow thickness was 2.58/1.57 mm. Mean/median follow-up was 56/53 months (1-132). SN positivity rate was 21%. US-FNAC Sensitivity was 71% (US only) and 51% (US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). PP, LCE and BS had sensitivity of 69%, 24% and 24% respectively. Sensitivity of US-FNAC increased with increasing SN tumour burden. PP was an early sign of metastasis (58% in <0.1mm metastases). Threshold size of a metastasis for FNAC was 0.3mm. Five-year survival correlated to US-FNAC status (95% in negative and 59% in positive). INTERPRETATION: Ultrasound guided FNAC (US-FNAC) according to the Berlin morphology criteria could correctly identify at least half of all tumour positive sentinel nodes, prior to the surgical SN procedure. Peripheral perfusion is an early sign of metastasis, which is very sensitive, but with lower positive predictive value (PPV). It is responsible for the sensitivity of the procedure. Balloon shape is a sign of advanced metastases, with lower sensitivity, but high PPV. US-FNAC sensitivity correlated with increasing T-stage, ulceration of the primary and increasing SN tumour burden. US-FNAC status accurately predicts survival.
BACKGROUND: Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanomapatients is controversial and subject of this study. METHODS: Between 2001 and 2010 over 1000 stage I/II consecutive melanomapatients prospectively underwent US-FNAC prior to SN biopsy. All patients underwent lymphoscintigraphy prior to US-FNAC. The Berlin US morphology criteria: Peripheral perfusion (PP), loss of central echoes (LCE) and balloon shaped (BS) were registered. FNAC was performed in case of presence of any of these factors. SN tumour burden was measured according to the Rotterdam criteria. All patients underwent SN or lymph node dissection (LND) in case of positive FNAC. FINDINGS: Mean/median Breslow thickness was 2.58/1.57 mm. Mean/median follow-up was 56/53 months (1-132). SN positivity rate was 21%. US-FNAC Sensitivity was 71% (US only) and 51% (US-FNAC). Sensitivity of US-FNAC was highest for T4 (76%) and ulcerated melanomas (63%). PP, LCE and BS had sensitivity of 69%, 24% and 24% respectively. Sensitivity of US-FNAC increased with increasing SN tumour burden. PP was an early sign of metastasis (58% in <0.1mm metastases). Threshold size of a metastasis for FNAC was 0.3mm. Five-year survival correlated to US-FNAC status (95% in negative and 59% in positive). INTERPRETATION: Ultrasound guided FNAC (US-FNAC) according to the Berlin morphology criteria could correctly identify at least half of all tumour positive sentinel nodes, prior to the surgical SN procedure. Peripheral perfusion is an early sign of metastasis, which is very sensitive, but with lower positive predictive value (PPV). It is responsible for the sensitivity of the procedure. Balloon shape is a sign of advanced metastases, with lower sensitivity, but high PPV. US-FNAC sensitivity correlated with increasing T-stage, ulceration of the primary and increasing SN tumour burden. US-FNAC status accurately predicts survival.
Authors: Matthew Fox; Marc Brown; Nicholas Golda; Dori Goldberg; Christopher Miller; Melissa Pugliano-Mauro; Chrysalyne Schmults; Thuzar Shin; Thomas Stasko; Yaohui G Xu; Kishwer Nehal Journal: J Am Acad Dermatol Date: 2018-09-15 Impact factor: 11.527
Authors: Jacqueline Dinnes; Lavinia Ferrante di Ruffano; Yemisi Takwoingi; Seau Tak Cheung; Paul Nathan; Rubeta N Matin; Naomi Chuchu; Sue Ann Chan; Alana Durack; Susan E Bayliss; Abha Gulati; Lopa Patel; Clare Davenport; Kathie Godfrey; Manil Subesinghe; Zoe Traill; Jonathan J Deeks; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2019-07-01
Authors: Charlotte M C Oude Ophuis; Lisa B Koppert; Cécile de Monyé; Carolien H M van Deurzen; Senada Koljenović; Alexander C J van Akkooi; Cornelis Verhoef; Dirk J Grünhagen Journal: BMC Cancer Date: 2017-04-12 Impact factor: 4.430
Authors: Daniëlle Verver; Charlotte M C Oude Ophuis; Lisa B Koppert; Cécile de Monyé; Carolien H M van Deurzen; Senada Koljenović; Annemarie Bruining; Bernies van der Hiel; Sylvia Ter Meulen; Alexander C J van Akkooi; Cornelis Verhoef; Dirk J Grünhagen Journal: Eur J Nucl Med Mol Imaging Date: 2018-04-26 Impact factor: 9.236
Authors: Andrea Ronchi; Marco Montella; Federica Zito Marino; Giuseppe Argenziano; Elvira Moscarella; Gabriella Brancaccio; Giuseppe Ferraro; Giovanni Francesco Nicoletti; Teresa Troiani; Renato Franco; Immacolata Cozzolino Journal: Cancer Cytopathol Date: 2021-07-26 Impact factor: 4.264