Ultrasonographic Evaluation of superficial lymph node metastases in melanoma

Department of Radiology, University of Padua, Italy.
European Journal of Radiology (Impact Factor: 2.37). 05/1997; 24(3):216-21. DOI: 10.1016/S0720-048X(96)01102-3
Source: PubMed


The aims of the present work were to assess the diagnostic accuracy of ultrasonographic evaluation of superficial lymph nodes in patients with cutaneous melanoma and to describe the sonographic characteristics which permit early detection of neoplastic nodal involvement. Eighty-seven patients (89 lymph node sites) were studied for approximately a 3-year period, with a minimal surveillance time of 1 year. The ultrasonographic imaging equipment utilized were a 10 MHz scanner with a mechanical and one with 10 MHz electronic linear probe. The characteristics considered indicative of possible metastatic involvement were: round shape (short to long axis ratio > 0.5), no central hilus, nodular areas within the lymph node, sinuosity of the lymph node edges and lymph node with regular morphology and echostructure but with maximum diameter greater than 3 cm. Generally inguinal and axillary lymph nodes are larger than cervical ones. Of the 89 sites explored, 32 were considered 'suspect'. All 32 of these were subjected to cytology using ultrasound-guided, fine needle aspiration. The remaining 56 came in for a periodic control examination during a year. Thirteen of the 32 'suspect' lymph nodes proved positive at the pathologic examination. Two patients whose ultrasound diagnosis was negative developed metastases within 2 to 4 months (ultrasound false negatives). Our study indicates that there are sonographic features indicative of lymph node metastases from melanoma even in the early stages of the disease. Ultrasound scanning, therefore, is a useful diagnostic tool in the follow-up of melanoma patients, identifying which should be subjected to further testing with needle biopsy.

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    • ". Also, color Doppler ultrasound (CDUS) provided functional imaging of the LNs which can be used to classify nodes as being reactive, metastatic, tuberculous, cystic, or enlarged secondary to lymphoma [21] "
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    ABSTRACT: Lymphatic vessels are a part of the circulatory system in vertebrates that maintain tissue fluid homeostasis and drain excess fluid and large cells that cannot easily find their way back into venous system. Due to the lack of noninvasive monitoring tools, lymphatic vessels are known as forgotten circulation. However, the lymphatic system plays an important role in diseases such as cancer and inflammatory conditions. In this paper, we start to briefly review the current existing methods for imaging lymphatic vessels, mostly involving dye/targeting cell injection. We then show the capability of optical coherence tomography (OCT) for label-free noninvasive in vivo imaging of lymph vessels and nodes. One of the advantages of using OCT over other imaging modalities is its ability to assess label-free blood flow perfusion that can be simultaneously observed along with lymphatic vessels for imaging the microcirculatory system within tissue beds. Imaging the microcirculatory system including blood and lymphatic vessels can be utilized for imaging and better understanding pathologic mechanisms and the treatment technique development in some critical diseases such as inflammation, malignant cancer angiogenesis, and metastasis.
    IEEE Journal of Selected Topics in Quantum Electronics 03/2014; 20(2):6800510-6800510. DOI:10.1109/JSTQE.2013.2278073 · 2.83 Impact Factor
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    • "US examinations were performed with a MyLab 70 XVC US system (Esaote s.p.a., Genoa, Italy) utilizing a LA 435 linear sensor, with frequency of between 6 and 18 MHz, or LA 523 (4–13 MHz). The examined lymph node was classified “negative” or “positive” on the basis of the radiologist’s opinion considering the US features.18 Specifically, lymph nodes that possessed at least one of the following characteristics were classified as “positive”: 1) round morphology (relation between the axial and longitudinal diameters < 2 in normal lymph nodes); 2) absence, attenuation or dislocation of the chillum; 3) eccentric cortical thickening or alteration of the contour of the lymph node; 4) lack of homogeneity in the cortical structure; 5) extracapsular extension; 6) one or more of the following vascular patterns: a) decrease in global vascularisation; b) cortical vascular structures of irregular calibre with a sharp interruption, tangential to the chillum rather than radial; c) absence of vascularisation in the chillum; d) the presence of peripheral vascular structures which penetrate into the cortical; e) highly or moderately resistant arterial signs or signs of a grossly altered morphology.14,18,19 "
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    ABSTRACT: The primary aim of this study was to evaluate the diagnostic accuracy of ultrasound (US) in the study of superficial lymph nodes during the follow-up of patients surgically treated for skin tumours. The secondary objective was to compare positive cytological results with histological reports. From 2004 to 2011, 480 patients (male/female: 285/195; median age 57 years; prevalent skin tumour: melanoma) underwent US-guided fine-needle aspiration biopsy (FNAB) of suspicious recurrent lymph nodes. An expert radiologist first performed US testing of the lymph nodes, expressing either a negative or positive outcome of the test. Subsequently, US-guided FNAB was performed. FNAB positive patients were subjected to lymphadenectomy; the patients who tested negative underwent the follow-up. The size of lymph nodes was ≤ 2 cm in 90% of cases. Out of the 336 (70%) US "positive" patients, 231 (68.8%) were FNAB positives. Out of the 144 (30%) US "negatives", 132 (91.7%) were FNAB negatives. The sensitivity and specificity of the US were 95% and 55.7%, respectively; the negative predictive value was 91.7% and the positive predictive value was 68.8%. Definitive histological results confirmed FNAB positivity in 97.5% of lymphadenectomies. US is a sensitive method in the evaluation of superficial lymph nodes during the follow-up of patients with skin tumours. High positive predictive value of cytology was confirmed.
    Radiology and Oncology 03/2014; 48(1):29-34. DOI:10.2478/raon-2013-0084 · 1.91 Impact Factor
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    • "Sonography of the lymph nodes was the most efficient technical method to detect relapses ( range : 10 – 16% ) in all phases of follow - up . This is in line with recent reports suggesting that lymph nodes sonography improves early detection of locoregional metastases ( Tregnaghi et al , 1997 ; Blum et al , 2000 ) . The efficiency - costs ratio in our study was best at initial staging and the follow - up in stage III . "
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    ABSTRACT: In a German cohort of 661 melanoma patients the performance, costs and survival benefits of staging methods (history and physical examination; chest X-ray; ultrasonography of the abdomen; high resolution sonography of the peripheral lymph nodes) were assessed at initial staging and during follow-up of stage I/II+III disease. At initial staging, 74% (23 out of 31) of synchronous metastases were first detected by physical examination followed by sonography of the lymph nodes revealing 16% (5 out of 31). Other imaging methods were less efficient (Chest X-ray: one out of 31; sonography of abdomen: two out of 31). Nearly 24% of all 127 first recurrences and 18% of 73 second recurrences developed in patients not participating in the follow-up programme. In follow-up patients detection of first or second recurrence were attributed to history and physical examination on a routine visit in 47 and 52% recurrences, respectively, and to routine imaging procedures in 21 and 17% of cases, respectively. Lymph node sonography was the most successful technical staging procedure indicating 13% of first relapses, but comprised 24% of total costs of follow-up in stage I/II. Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III. The mode of detecting a relapse (‘patient vs. doctor-diagnosed’ or ‘symptomatic vs asymptomatic’) did not significantly influence patients overall survival. Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient. British Journal of Cancer (2002) 87, 151–157. doi:10.1038/sj.bjc.6600428 © 2002 Cancer Research UK
    British Journal of Cancer 08/2002; 87(2):151-7. DOI:10.1038/sj.bjc.6600428 · 4.84 Impact Factor
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