ORIGINAL ARTICLESThe contribution of high-resolution ultrasonography in preoperatively detecting sentinel-node metastases in melanoma patientsSibon, Clairea; Chagnon, Sophieb; Tchakérian, Arnolda; Bafounta, Marie-Lisea; Longvert, Christinea; Clerici, Thierryc; Zimmermann, Utec; Saiag, PhilippeaAuthor Information Departments of aDermatology bRadiology cPathology Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France Correspondence to Dr Claire Sibon, Service de Dermatologie, Hôpital Ambroise Paré, 9 avenue Charles de Gaulles, 92100 Boulogne-Billancourt, France Tel: +33 1 49 09 56 73; e-mail: [email protected] Received 5 March 2007 Accepted 2 June 2007 Melanoma Research: August 2007 - Volume 17 - Issue 4 - p 233-237 doi: 10.1097/CMR.0b013e3282c3a65a Buy Metrics Abstract To evaluate the ability of high-resolution ultrasonography (hrUS) to detect sentinel-node (SN) melanoma metastases preoperatively before sentinel-node biopsy (SNB), to define hrUS resolution, and to evaluate which US criteria should be used. During a 6.5-year period, 131 consecutive patients with 132 ≥1-mm thick or ulcerated cutaneous melanomas, who were followed up at a single center, were enrolled. All patients underwent preoperative regional lymph-node hrUS and SNB. We used the recently evaluated ultrasonographic stringent and nonstringent hrUS criteria to detect SN metastases. Sizes of the SN metastatic deposits were measured under light microscopy. Thirty-five (27%) patients had a positive SNB. HrUS identified only three positive SNs as being metastatic. Sensitivity and specificity using stringent criteria were 8.8% [95% confidence interval (CI, 2.3–24.8%) and 95.9% (95% CI, 89.3–98.7%)], respectively. Positive-predictive value was 42.9% (95% CI, 11.9–79.9%). The nonstringent criteria provided four additional true-positive results, but lowered specificity (89.8%; 95% CI, 81.6–94.7%) with no significant improvement in sensitivity (20.6%; 95% CI, 9.3–38.4%). Positive-predictive value using nonstringent criteria was 41.2% (95% CI, 19.3–66.4%). HrUS failed to detect all metastatic deposits <5 mm in diameter. HrUS assessment of early-stage melanomas cannot replace surgical SNB. Owing to its low positive-predictive value, hrUS was unable to identify patients who would have to proceed directly to completion lymphadenectomy. © 2007 Lippincott Williams & Wilkins, Inc.