Ultrasonographic findings validity in the identification of metastatic regional lymph nodes in patients with cutaneous melanoma

Abstract

Background/Aim. Early identification of lymph node (LN) metastases has both therapeutic and prognostic significance in patients with cutaneous melanoma. Ultrasonographic (US) examination of LN morphological characteristics and US of LN morphological and vascular characteristics are diagnostic methods used in identification of regional LN metastases, thus rendering a base for lymphonododisection indication. The aim of this study was to determine validity of these two US diagnostic methods and eventual statistically significant difference between them. Methods. The study included the two groups of the patients with clinical stage III melanoma. The group I included 31 patients followed up by the use of US of LN morphological characteristics due to the fact that US findings described them only. The group II included 30 patients in whom morphological and vascular LN characteristics were followed up. The patients of both groups were examined in the Institute for Radiology, Military Medical Academy using an ultrasonographic unit type Akuson Sequoia Model 2000. After that, therapeutic and elective radical disections were performed. Sensitivity, specificity and accuracy of US examination of LN were checked by histopathological examination. Results. The presence of LN metastases in the group I was suggested by LN enlargement and its extent, while in the group II it was suggested by the ratio of LN length and width in 83.3% of the patients, echogenicity of LN center in 76.7% of the patients, LN resistance index in 73.3% of the patients, pathologic LN vascularization in 86.7%, and pathologic intranodal arborization in 83.3% of the patients. In 67.7% of the patients in the group I and in 93.3% of the patients in the group II matastatic changes of LN were diagnosed by pathohistology. A difference between validities of the two groups was statistically significant (p < 0.05). Conclusion. LN size without other US morphological and vascular characteristics of LN does not provide enough valid US finding for a reliable preoperative identification of LN with metastatic changes in patients with cutaneous melanoma.