Ultrasound advisable when assessing lymph node metastasis in patients with AJCC T2b stage and above
June 13, 2019
Abstract
Background: There is no consensus on the imaging tests that should be performed at the initial staging of melanoma patients.
Objective: Evaluate the diagnostic accuracy of four imaging studies for the initial staging of melanoma patients.
Methods: Cross-sectional study with prospectively collected data, from January 2011 to April 2017, including patients with clinical stage T2b to T4b (AJCC 2009), without evidence of metastasis.
Results: Initial staging of 308 patients detected 16.6% of metastases and 5.8% false positive results, overall. Regional lymph node ultrasonography showed a metastasis detection rate (MDR) 12.8%, false positive rate (FPR) 0.8% and accuracy (ACC) 96.0%. Computed tomography (CT) and positron emission tomography-CT (PET-CT) had the highest detection rates at stage T4b (MDR 13.3%, FPR 8.9%, ACC 91.1%) and (MDR 6.9%, FPR 0%, ACC 93.1%) respectively. Brain MRI showed a MDR of 2.0% in T4b.
Limitations: Single-center study.
Conclusion: Performing ultrasound for assessing lymph node metastasis in patients with AJCC T2b stage and above is advisable. In patients with stage T4b, CT or PET-CT are suitable for the detection of metastasis. Brain MRI at T4b deserves further discussion, considering ultimate clinical benefit in terms of management and therapeutic options for asymptomatic patients.
Source:
Loughlin, C. R., Podlipnik, S., Bosch-Amate, X., Riera-Monroig, J., Barreiro, A., Espinosa, N., . . . Puig, S. (2019). Diagnostic accuracy of imaging studies for initial staging of T2b-T4b melanoma patients. A cross-sectional study. Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2019.05.076