ULTRASONOGRAPHIC EVALUATION OF SUPERFICIAL LYMPH-NODE METASTASES IN MELANOMA

The aims of the present work were to assess the diagnostic accuracy of ultrasonographic evaluation of superficial lymph nodes in patients wi th cutaneous melanoma and to describe the sonographic characteristics which permit early detection of neoplastic nodal involvement. Eighty-s even patients (89 lymph node sites) were studied for approximately a 3 -year period, with a minimal surveillance time of 1 year. The ultrason ographic imaging equipment utilized were a 10 MHz scanner with a mecha nical 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 area s within the lymph node, sinuosity of the lymph node edges and lymph n ode with regular morphology and echostructure but with maximum diamete r greater than 3 cm. Generally inguinal and axillary lymph nodes are l arger than cervical ones. Of the 89 sites explored, 32 were considered 'suspect'. All 32 of these were subjected to cytology using ultrasoun d-guided, fine needle aspiration. The remaining 56 came in for a perio dic control examination during a year. Thirteen of the 32 'suspect' ly mph 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 the re are sonographic features indicative of lymph node metastases from m elanoma even in the early stages of the disease. Ultrasound scanning, therefore, is a useful diagnostic tool in the follow-up of melanoma pa tients, identifying which should be subjected to further testing with needle biopsy. (C) 1997 Elsevier Science Ireland Ltd.