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Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node biopsy (SLNB) is widely used in melanoma. Identifying nodal involvement preoperatively by high-resolution ultrasound may offer less invasive staging. This study assessed feasibility and staging results of clinically targeted ultrasound (before lymphoscintigraphy) compared to SLNB.

Methods

From 2005 to 2009, a total of 325 patients with melanoma underwent ultrasound before SLNB. We reviewed demographics and histopathologic characteristics, then compared ultrasound and SLNB results. Sensitivity, specificity, and positive and negative predictive value were determined.

Results

A total of 325 patients were included, 58% men and 42% women with a median age of 58 (range 18–86) years. A total of 471 basins were examined with ultrasound. Only six patients (1.8%) avoided SLNB by undergoing ultrasound-guided fine-needle aspiration of involved nodes, then therapeutic lymphadenectomy. Sixty-five patients (20.4%) had 69 SLNB positive nodal basins; 17 nodal basins from 15 patients with positive ultrasounds were considered truly positive. Forty-five SLNB positive basins had negative ultrasounds (falsely negative). Seven node-positive basins did not undergo ultrasound because of unpredicted drainage. A total of 253 patients with negative SLNBs had negative ultrasounds in 240 nodal basins (truly negative) but falsely positive ultrasounds occurred in 40 basins. Overall, sensitivity of ultrasound was 33.8%, specificity 85.7%, positive predictive value 36.5%, and negative predictive value 84.2%. Sensitivity and specificity improved somewhat with increasing Breslow depth. Sensitivity was highest for the neck, but specificity was highest for the groin.

Conclusions

Routine preoperative ultrasound in clinically node-negative melanoma is impractical because of its low sensitivity. Selected patients with thick or ulcerated lesions may benefit. Because of variable lymphatic drainage patterns, preoperative ultrasound without lymphoscintigraphic localization will provide incomplete evaluation in many cases.

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Author information

Authors and Affiliations

  1. Department of Surgery, San Antonio Military Medical Center, San Antonio, TX, USA

    Christy Y. Chai MD

  2. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Jonathan S. Zager MD, Suroosh S. Marzban MS, Robert M. Rossi BS & Vernon K. Sondak MD

  3. Departments of Oncologic Sciences and Surgery, University of South Florida College of Medicine, Tampa, FL, USA

    Jonathan S. Zager MD & Vernon K. Sondak MD

  4. Division of Women’s Radiology, University of Kentucky College of Medicine, Lexington, KY, USA

    Margaret M. Szabunio MD

  5. Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA

    Alec Chau MD

Authors
  1. Christy Y. Chai MD
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  2. Jonathan S. Zager MD
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  3. Margaret M. Szabunio MD
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  4. Suroosh S. Marzban MS
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  5. Alec Chau MD
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  6. Robert M. Rossi BS
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  7. Vernon K. Sondak MD
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Correspondence to Vernon K. Sondak MD.

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Chai, C.Y., Zager, J.S., Szabunio, M.M. et al. Preoperative Ultrasound is Not Useful for Identifying Nodal Metastasis in Melanoma Patients Undergoing Sentinel Node Biopsy: Preoperative Ultrasound in Clinically Node-Negative Melanoma. Ann Surg Oncol 19, 1100–1106 (2012). https://doi.org/10.1245/s10434-011-2172-7

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  • DOI: https://doi.org/10.1245/s10434-011-2172-7

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