Originally published as JCO Early Release 10.1200/JCO.2008.19.0033 on September 8 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Voit, C. A. Articles by Eggermont, A. M.M. PubMed PubMed Citation Articles by Voit, C. A. Articles by Eggermont, A. M.M. Social Bookmarking                            What's this?

Rotterdam Criteria for Sentinel Node (SN) Tumor Burden and the Accuracy of Ultrasound (US) -Guided Fine-Needle Aspiration Cytology (FNAC): Can US-Guided FNAC Replace SN Staging in Patients With Melanoma?

Christiane A. Voit, Alexander C.J. van Akkooi, Gregor Schäfer-Hesterberg, Alfred Schoengen, Paul I.M. Schmitz, Wolfram Sterry, Alexander M.M. Eggermont

From the Department of Dermatology, Charité, Humboldt University, Berlin; Department of Medical Oncology, Armed Forces Hospital, University of Ulm, Ulm, Germany; and Departments of Surgical Oncology and Statistics, Erasmus University Medical Center–Daniel den Hoed Cancer Center, the Netherlands.

Corresponding author: Christiane Voit, MD, Department of Dermatology, Charité, Humboldt University, Berlin, Schumannstr 20/21, 10117 Berlin, Germany; e-mail: christiane.voit{at}t-online.de.

Purpose Sentinel node (SN) status is the most important prognostic factor for overall survival (OS) for patients with stage I/II melanoma, and the role of the SN procedure as a staging procedure has long been established. However, a less invasive procedure, such as ultrasound (US) -guided fine-needle aspiration cytology (FNAC), would be preferred. The aim of this study was to evaluate the accuracy of US-guided FNAC and compare the results with histology after SN surgery was performed in all patients.

Patients and Methods Four hundred consecutive patients who underwent lymphoscintigraphy subsequently underwent a US examination before the SN procedure. When the US examination showed a suspicious or malignant pattern, patients underwent an FNAC. Median Breslow thickness was 1.8 mm; mean follow-up was 42 months (range, 4 to 82 months). We considered the US-guided FNAC positive if either US and/or FNAC were positive. If US was suggestive of abnormality, but FNAC was negative, the US-guided FNAC was considered negative.

Results US-guided FNAC identified 51 (65%) of 79 SN metastases. Specificity was 99% (317 of 321), with a positive predictive value of 93% and negative predictive value of 92%. SN-positive identification rate by US-guided FNAC increased from 40% in stage pT1a/b disease to 79% in stage pT4a/b disease. US-guided FNAC detected SN tumors more than 1.0 mm in 86% of cases, SN tumors of 0.1 to 1.0 mm in 46% of cases, and SN tumors less than 0.1 mm in 23% of cases. Estimated 5-year OS rates were 92% for patients with negative US-guided FNAC results and 51% for patients with positive results.

Conclusion US-guided FNAC of SNs is highly accurate. Up to 65% of the patients with SN-positive results in our institution could have been spared an SN procedure.

Both C.A.V. and A.C.J.v.A. contributed equally to this work.

Supported by Deutsche Krebshilfe (Grant No. 70-2791-Vo I).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?