Diagnostic Accuracy of Image-guided Biopsies for Diagnosis of Metastatic Melanoma in a Real-life Setting
DOI:
https://doi.org/10.2340/actadv.v102.3981Keywords:
core-needle biopsy, diagnostic imaging, fine-needle aspiration biopsy, image-guided biopsy, melanoma, metastasisAbstract
Early detection of melanoma metastasis is essential in order to initiate treatment and improve patient prognosis. The aim of this study was to determine the diagnostic accuracy of different image-guided biopsy techniques in patients with melanoma. A cohort study of patients diagnosed with melanoma who had undergone image-guided biopsies (ultrasound-guided fine-needle aspiration cytology, ultrasound-guided core-needle biopsy, computerized tomography-guided fine-needle aspiration cytology and computerized tomography-guided core-needle biopsy) to detect melanoma metastasis between 2004 and 2021 was conducted. The reference standard was histological confirmation and/or clinical-radiological follow-up. Sensitivity, specificity, positive and negative predictive values were calculated. A total of 600 image-guided biopsies performed on 460 patients were included for analysis. Locoregional lesions represented 459 (76.5%) biopsies, and 141 (23.5%) were distant lesions. Of the included biopsies, 49 (8.2%) were insufficient for diagnosis. Overall, sensitivity and specificity were 92% (95% confidence interval 89–94) and 96% (95% confidence interval 91–99), respectively. Sensitivity sub-analyses revealed lower diagnostic accuracy values in the lung, inguinal lymph nodes, and computerized tomography-guided lesions under 1 cm. Limitations include spontaneous metastasis regression and arbitrary minimum follow-up period. Image-guided biopsies in patients with melanoma have high sensitivity and specificity for detection of regional or distant metastasis. Tissue type, location and tumour burden may influence the diagnostic accuracy of the test.
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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7-30.
https://doi.org/10.3322/caac.21590 DOI: https://doi.org/10.3322/caac.21590
Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Invest Dermatol 2016; 136: 1161-1171.
https://doi.org/10.1016/j.jid.2016.01.035 DOI: https://doi.org/10.1016/j.jid.2016.01.035
Melanoma of the Skin-Cancer Stat Facts. SEER [cited 2022 Jan 3] Available from: https://seer.cancer.gov/statfacts/html/melan.html.
Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017; 376: 2211-2222.
https://doi.org/10.1056/NEJMoa1613210 DOI: https://doi.org/10.1056/NEJMoa1613210
Podlipnik S, Carrera C, Sánchez M, Arguis P, Olondo ML, Vilana R, et al. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: a prospective cohort study. J Am Acad Dermatol 2016; 75: 516-524.
https://doi.org/10.1016/j.jaad.2016.02.1229 DOI: https://doi.org/10.1016/j.jaad.2016.02.1229
Ascierto PA, Long GV, Robert C, Brady B, Dutriaux C, Di Giacomo AM, et al. Survival outcomes in patients with previously untreated BRAF wild-type advanced melanoma treated with nivolumab therapy: three-year follow-up of a randomized phase 3 trial. JAMA Oncol 2019; 5: 187-194.
https://doi.org/10.1001/jamaoncol.2018.4514 DOI: https://doi.org/10.1001/jamaoncol.2018.4514
National Comprehensive Cancer Network (NCCN). Melanoma: cutaneous. Version 1.2022. [cited 2022 Jan 3]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf.
Murali R, Doubrovsky A, Watson GF, McKenzie PR, Lee CS, McLeod DJ, et al. Diagnosis of metastatic melanoma by fine-needle biopsy: analysis of 2,204 cases. Am J Clin Pathol 2007; 127: 385-397.
https://doi.org/10.1309/3QR4FC5PPWXA7N29 DOI: https://doi.org/10.1309/3QR4FC5PPWXA7N29
Hall BJ, Schmidt RL, Sharma RR, Layfield LJ. Fine-needle aspiration cytology for the diagnosis of metastatic melanoma. Am J Clin Pathol 2013; 140: 635-642.
https://doi.org/10.1309/AJCPWSDDHLLW40WI DOI: https://doi.org/10.1309/AJCPWSDDHLLW40WI
Dalle S, Paulin C, Lapras V, Balme B, Ronger-Savle S, Thomas L. Fine-needle aspiration biopsy with ultrasound guidance in patients with malignant melanoma and palpable lymph nodes. Br J Dermatol 2006; 155: 552-556.
https://doi.org/10.1111/j.1365-2133.2006.07361.x DOI: https://doi.org/10.1111/j.1365-2133.2006.07361.x
Riquelme-Mc Loughlin C, Podlipnik S, Bosch-Amate X, Riera-Monroig J, Barreiro A, Espinosa N, et al. Diagnostic accuracy of imaging studies for initial staging of T2b to T4b melanoma patients: a cross-sectional study. J Am Acad Dermatol 2019; 81: 1330-1338.
https://doi.org/10.1016/j.jaad.2019.05.076 DOI: https://doi.org/10.1016/j.jaad.2019.05.076
Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 2016; 6: e012799.
https://doi.org/10.1136/bmjopen-2016-012799 DOI: https://doi.org/10.1136/bmjopen-2016-012799
De Fiori E, Rampinelli C, Turco F, Bonello L, Bellomi M. Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid. Radiol Med (Torino) 2010; 115: 612-618.
https://doi.org/10.1007/s11547-010-0528-x DOI: https://doi.org/10.1007/s11547-010-0528-x
Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH, Chew K, et al. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer 2001; 93: 263-268.
https://doi.org/10.1002/cncr.9040 DOI: https://doi.org/10.1002/cncr.9040
Murali R, Thompson JF, Uren RF, Scolyer RA. Fine-needle biopsy of metastatic melanoma: clinical use and new applications. Lancet Oncol 2010; 11: 391-400.
https://doi.org/10.1016/S1470-2045(09)70332-8 DOI: https://doi.org/10.1016/S1470-2045(09)70332-8
Voit CA, van Akkooi ACJ, Eggermont AMM, Schäfer-Hesterberg G, Kron M, Ulrich J, et al. Fine needle aspiration cytology of palpable and nonpalpable lymph nodes to detect metastatic melanoma. J Natl Cancer Inst 2011; 103: 1771-1777.
https://doi.org/10.1093/jnci/djr381 DOI: https://doi.org/10.1093/jnci/djr381
Bohelay G, Battistella M, Pagès C, de Margerie-Mellon C, Basset-Seguin N, Viguier M, et al. Ultrasound-guided core needle biopsy of superficial lymph nodes: an alternative to fine-needle aspiration cytology for the diagnosis of lymph node metastasis in cutaneous melanoma. Melanoma Res 2015; 25: 519-527.
https://doi.org/10.1097/CMR.0000000000000161 DOI: https://doi.org/10.1097/CMR.0000000000000161
Rodrigues LK, Leong SP, Ljung BM, Sagebiel RW, Burnside N, Hu T, et al. Fine needle aspiration in the diagnosis of metastatic melanoma. J Am Acad Dermatol 2000; 42: 735-740.
https://doi.org/10.1067/mjd.2000.103812 DOI: https://doi.org/10.1067/mjd.2000.103812
Basler GC, Fader DJ, Yahanda A, Sondak VK, Johnson TM. The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes. J Am Acad Dermatol 1997; 36: 403-408.
https://doi.org/10.1016/S0190-9622(97)80216-2 DOI: https://doi.org/10.1016/S0190-9622(97)80216-2
Perry MD, Seigler HF, Johnston WW. Diagnosis of metastatic malignant melanoma by fine needle aspiration biopsy: a clinical and pathologic correlation of 298 cases. J Natl Cancer Inst 1986; 77: 1013-1021.
Voit C, Mayer T, Proebstle TM, Weber L, Kron M, Krupienski M, et al. Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases. Cancer Cytopathol 2000; 90: 186-193.
https://doi.org/10.1002/1097-0142(20000625)90:3<186::AID-CNCR7>3.0.CO;2-O DOI: https://doi.org/10.1002/1097-0142(20000625)90:3<186::AID-CNCR7>3.0.CO;2-O
Cangiarella J, Symmans WF, Shapiro RL, Roses DF, Cohen JM, Chhieng D, et al. Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes. Cancer 2000; 90: 162-166.
https://doi.org/10.1002/1097-0142(20000625)90:3<162::AID-CNCR4>3.0.CO;2-6 DOI: https://doi.org/10.1002/1097-0142(20000625)90:3<162::AID-CNCR4>3.0.CO;2-6
Barkan GA, Rubin MA, Michael CW. Diagnosis of melanoma aspirates on ThinPrep: the University of Michigan experience. Diagn Cytopathol 2002; 26: 334-339.
https://doi.org/10.1002/dc.10099 DOI: https://doi.org/10.1002/dc.10099
Kalialis LV, Drzewiecki KT, Klyver H. Spontaneous regression of metastases from melanoma: review of the literature. Melanoma Res 2009; 19: 275-282.
https://doi.org/10.1097/CMR.0b013e32832eabd5 DOI: https://doi.org/10.1097/CMR.0b013e32832eabd5
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Copyright (c) 2022 Laura Serra-García, Jesica Eliana-Radonich, Ignasi Marti-Marti, Ramon Vilana, Enric Ripoll, Marcelo Sánchez, Llúcia Alós, Cristina Carrera, Susana Puig, Josep Malvehy, Sebastian Podlipnik
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