In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e20035-e20035
Abstract:
e20035 Background: The surgical Sentinel Node (SN) is standard of care worldwide for the staging of AJCC stage I/II melanoma patients. It remains unclear if SN followed by early lymph node dissection in case of metastasis can lead to a survival benefit. Unlike other cancers, US-guided-FNAC has not been proven effective in melanoma. Aim was to analyze sensitivity (sens), specificity (spec), positive (PPV) and Negative (NPV) predictive values with use of the Berlin Morphology criteria, a low threshold for performing repeated FNAC and overnight cytology reports. Methods: Between 2001 and 2010 over 1,000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy prior to US-FNAC. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) are the Berlin Morphology Criteria, which were registered. FNAC was performed (3-4x) in case any of these factors were seen. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/med Breslow thickness 2.59/1.57 mm (0.2 – 44 mm). Mean/med follow-up 39 / 32 months (0 – 115). Ulceration (ulc) present in 24 %. SN pos rate was 20.8 % (208 / 1000). 34.2% underwent FNAC. 8.9% was FNAC positive; this was 26% of all FNAC. Sens was 51%. Spec, PPV and NPV were 99%, 95% and 89%. Sensitivity was highest for T4 (76%) and in ulc (63%) tumors. PP, LCE, BS had sens of 51%, 37%, 24%. Sens of US-FNAC increased with increasing SN tumor burden (12% in 〈 0.1 mm to 61% in 〉 1 mm). PP was an early sign of metastasis (58% in 〈 0.1 mm mets). Threshold for pos FNAC was 0.4 mm in maximum diameter. 5-yr survival correlated to US-FNAC status (93% in neg, 51% in pos). 5-yr survival of pts with PP was 82% vs. 46% in BS vs. 92% in neg pts (P=0.001). Conclusions: US-FNAC according to the Berlin Morphology criteria can correctly identify half of the positive SNs, prior to the surgical SN procedure. PP is an early sign of metastasis, BS is a late sign. US-FNAC can significantly reduce the amount of unnecessary surgical SN procedures. US-FNAC sensitivity correlated with increasing T-stage, increasing SN tumor burden and ulc. US-FNAC can accurately predict survival.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2013.31.15_suppl.e20035
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2013
detail.hit.zdb_id:
2005181-5
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