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Actas Dermosifiliogr. 2017 Dec;108(10):931-938. doi: 10.1016/j.ad.2017.06.002. Epub 2017 Aug 8.

Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis.

[Article in English, Spanish]

Author information

1
Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
2
Facultad de Medicina, Universidad Católica de Valencia, Valencia, España.
3
Servicio de Radiodiagnóstico, Instituto Valenciano de Oncología, Valencia, España.
4
Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España.
5
Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, España.
6
Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España.
7
Unidad de Gestión Clínica de Dermatología MQ, Hospital Universitario Virgen Macarena, Sevilla, España.
8
Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España. Electronic address: eduardo_nagore@ono.com.

Abstract

BACKGROUND AND OBJECTIVES:

Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB.

MATERIALS AND METHODS:

We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy.

RESULTS:

Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00).

CONCLUSIONS:

Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.

KEYWORDS:

Biopsia; Biopsy; Cost-effectiveness; Coste-efectividad; Ecografía; Estadificación; Ganglio centinela; Melanoma; Sentinel lymph node; Staging; Ultrasound

PMID:
28801012
DOI:
10.1016/j.ad.2017.06.002
[Indexed for MEDLINE]

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