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Diagnostic Accuracy of Fine Needle Biopsy for Metastatic Melanoma and Its Implications for Patient Management

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Abstract

Background

The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated.

Methods

A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up.

Results

FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results.

Conclusions

FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma.

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References

  1. Geisinger KR, Stanley MW, Raab SS, et al. Modern Cytopathology. Philadelphia: Churchhill Livingston, 2004

  2. Orell SR, Stenett GF, Walters MN, et al. Manual and Atlas of Fine Needle Aspiration Cytology. Philadelphia: Churchhill Livingston, 1999

  3. Steel BL, Schwartz MR, Ramzy I. Fine needle aspiration biopsy in the diagnosis of lymphadenopathy in 1,103 patients. Role, limitations and analysis of diagnostic pitfalls. Acta Cytol 1995; 39:76–81

    PubMed  CAS  Google Scholar 

  4. Lussier C, Klijanienko J, Vielh P. Fine-needle aspiration of metastatic nonlymphomatous tumors to the major salivary glands: a clinicopathologic study of 40 cases cytologically diagnosed and histologically correlated. Cancer 2000; 90:350–6

    Article  PubMed  CAS  Google Scholar 

  5. Bofin AM, Lydersen S, Isaksen C, Hagmar BM. Interpretation of fine needle aspiration cytology of the breast: a comparison of cytological, frozen section, and final histological diagnoses. Cytopathology 2004; 15:297–304

    Article  PubMed  CAS  Google Scholar 

  6. Logrono R, Kurtycz DF, Sproat IA, Shalkham JE, Stewart JA, Inhorn SL. Multidisciplinary approach to deep-seated lesions requiring radiologically-guided fine-needle aspiration. Diagn Cytopathol 1998; 18:338–42

    Article  PubMed  CAS  Google Scholar 

  7. Basler GC, Fader DI, Yahanda A, Sondak VK, Johnson TM. The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes. J Am Acad Dermatol 1997; 36:403–8

    Article  PubMed  CAS  Google Scholar 

  8. Cangiarella J, Symmans WF, Shapiro RL, et al. Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes. Cancer 2000; 90:162–6

    Article  PubMed  CAS  Google Scholar 

  9. Rodrigues LK, Leong SP, Ljung BM, et al. Fine needle aspiration in the diagnosis of metastatic melanoma. J Am Acad Dermatol 2000; 42:735–40

    Article  PubMed  CAS  Google Scholar 

  10. Hafstrom L, Hugander A, Jonsson PE, Lindberg LG. Fine-needle-aspiration cytodiagnosis of recurrent malignant melanoma. J Surg Oncol 1980; 15:229–34

    Article  PubMed  CAS  Google Scholar 

  11. Perry MD, Seigler HF, Johnston WW. Diagnosis of metastatic malignant melanoma by fine needle aspiration biopsy: a clinical and pathologic correlation of 298 cases. J Natl Cancer Inst 1986; 77:1013–21

    PubMed  CAS  Google Scholar 

  12. Voit C, Mayer T, Proebstle TM, et al. Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases. Cancer 2000; 90:186–93

    Article  PubMed  CAS  Google Scholar 

  13. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19:3635–48

    PubMed  CAS  Google Scholar 

  14. Einstein AJ, Bodian CA, Gil J. The relationships among performance measures in the selection of diagnostic tests. Arch Pathol Lab Med 1997; 121:110–7

    PubMed  CAS  Google Scholar 

  15. Habbema JDF, Eijkemans R, Krijnen P, Knottnerus JA. Analysis of data on the accuracy of diagnostic tests. In: Knottnerus JA. ed. The Evidence Base of Clinical Diagnosis. BMJ Publishing Group, London, 2002: 117–43

  16. Raab SS, Bottles K, Cohen MB. Technology assessment in anatomic pathology. An illustration of test evaluation using fine-needle aspiration biopsy. Arch Pathol Lab Med 1994; 118:1173–80

    PubMed  CAS  Google Scholar 

  17. Lijmer JG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999; 282:1061–6

    Article  PubMed  CAS  Google Scholar 

  18. Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J. Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004; 140:189–202

    PubMed  Google Scholar 

  19. Panzer RJ, Suchman AL, Griner PF. Workup bias in prediction research. Med Decis Making 1987; 7:115–9

    Article  PubMed  CAS  Google Scholar 

  20. Katz KA, Jonasch E, Hodi FS, et al. Melanoma of unknown primary: experience at Massachusetts General Hospital and Dana-Farber Cancer Institute. Melanoma Res 2005; 15:77–82

    Article  PubMed  Google Scholar 

  21. Vijuk G, Coates AS. Survival of patients with visceral metastatic melanoma from an occult primary lesion: a retrospective matched cohort study. Ann Oncol 1998; 9:419–22

    Article  PubMed  CAS  Google Scholar 

  22. Murali R, Doubrovsky A, Watson GF, et al. Diagnosis of metastatic melanoma by fine needle biopsy: analysis of 2204 cases. Am J Clin Pathol 2007; 127:385–97

    Google Scholar 

  23. Cohen MB, Rodgers RP, Hales MS, et al. Influence of training and experience in fine-needle aspiration biopsy of breast. Receiver operating characteristics curve analysis. Arch Pathol Lab Med 1987; 111:518–20

    CAS  Google Scholar 

  24. Perry MD, Gore M, Seigler HF, Johnston WW. Fine needle aspiration cytology of metastatic melanoma: a morphological analysis of 174 cases. Acta Cytol 1985; 30:386–96

    Google Scholar 

  25. Layfield LJ, Ostrzega N. Fine needle aspirate smear morphology in metastatic melanoma. Acta Cytol 1989; 33:606–12

    PubMed  CAS  Google Scholar 

  26. Nasiell K, Tani E, Skoog L. Fine needle aspiration cytology and immunocytochemistry of metastatic melanoma. Cytopathology 1991; 2:137–47

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Anna Doubrovsky was supported by the University of Sydney Cancer Research Fund. Rajmohan Murali is supported by the Cancer Institute NSW Clinical Fellowship Program. The invaluable assistance of Ms. Marjorie Colman, the staff of the Department of Cytology and the Sydney Melanoma Unit at the Royal Prince Alfred Hospital are acknowledged. This study was also supported by the University of Sydney Cancer Research Fund, the Cancer Institute NSW, the National Health and Medical Research Council, and the Melanoma Foundation, University of Sydney.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    Anna Doubrovsky, Richard A. Scolyer, Rajmohan Murali, William H. McCarthy, Jonathan R. Stretch, Robyn P. Saw & John F. Thompson

  2. Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Richard A. Scolyer, Rajmohan Murali, Paul R. McKenzie, Geoffrey F. Watson, C. Soon Lee & Duncan J. McLeod

  3. Nuclear Medicine and Diagnostic Ultrasound and Discipline of Medicine, The University of Sydney, Sydney, NSW, Australia

    Roger F. Uren

  4. Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

    William H. McCarthy, Jonathan R. Stretch, Robyn P. Saw & John F. Thompson

  5. Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

    Richard A. Scolyer, Rajmohan Murali & C. Soon Lee

  6. Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, New South Wales, Camperdown, Australia

    Richard A. Scolyer, Rajmohan Murali, William H. McCarthy, Jonathan R. Stretch, Robyn P. Saw & John F. Thompson

Authors
  1. Anna Doubrovsky
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  2. Richard A. Scolyer
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  3. Rajmohan Murali
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  4. Paul R. McKenzie
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  5. Geoffrey F. Watson
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  6. C. Soon Lee
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  7. Duncan J. McLeod
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  8. William H. McCarthy
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  9. Roger F. Uren
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  10. Jonathan R. Stretch
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  11. Robyn P. Saw
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  12. John F. Thompson
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Corresponding author

Correspondence to John F. Thompson.

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Doubrovsky, A., Scolyer, R.A., Murali, R. et al. Diagnostic Accuracy of Fine Needle Biopsy for Metastatic Melanoma and Its Implications for Patient Management. Ann Surg Oncol 15, 323–332 (2008). https://doi.org/10.1245/s10434-006-9341-0

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  • DOI: https://doi.org/10.1245/s10434-006-9341-0

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