1
|
Liu ZF, Sylivris A, Wu J, Tan D, Hong S, Lin L, Wang M, Chew C. Ultrasound Surveillance in Melanoma Management: Bridging Diagnostic Promise with Real-World Adherence: A Systematic Review and Meta-Analysis. Am J Clin Dermatol 2024:10.1007/s40257-024-00862-3. [PMID: 38635019 DOI: 10.1007/s40257-024-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Ultrasound surveillance has become the new standard of care in stage III melanoma after the 2017 Multicenter Selective Lymphadenectomy Trial II (MSLT-II) demonstrated non-inferior 3-year survival compared with complete lymph node dissection. OBJECTIVE We aimed to quantify diagnostic performance and adherence rates of ultrasound surveillance for melanoma locoregional metastasis, offering insights into real-world applicability. METHODS Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched the Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases from inception until 11 October 2023. All primary studies that reported data on the diagnostic performance or adherence rates to ultrasound surveillance in melanoma were included. R statistical software was used for data synthesis and analysis. Sensitivity and specificity were aggregated across studies using the meta-analytic method for diagnostic tests outlined by Rutter and Gatsonis. Adherence rates were calculated as the ratio of patients fully compliant to planned follow-up to those who were not. RESULTS A total of 36 studies including 18,273 patients were analysed, with a mean age of 56.6 years and a male-to-female ratio of 1:1.11. The median follow-up duration and frequency was 36 and 4 months, respectively. The pooled sensitivity of ultrasound examination was 0.879 (95% confidence interval [CI] 0.878-0.879) and specificity was 0.969 (95% CI 0.968-0.970), representing a diagnostic odds ratio of 224.5 (95% CI 223.1-225.9). Ultrasound examination demonstrated a substantial improvement in absolute sensitivity over clinical examination alone, with a number needed to screen (NNS) of 2.95. The overall adherence rate was 77.0% (95% CI 76.0-78.1%), with significantly lower rates in the United States [US] (p < 0.001) and retrospective studies (p < 0.001). CONCLUSION Ultrasound is a powerful diagnostic tool for locoregional melanoma metastasis. However, the real applicability to surveillance programmes is limited by low adherence rates, especially in the US. Further studies should seek to address this adherence gap.
Collapse
Affiliation(s)
- Zhao Feng Liu
- Department of Dermatology, Alfred Health, Melbourne, VIC, Australia
| | | | - Johnny Wu
- Monash Health, Clayton, VIC, Australia
| | - Darren Tan
- Faculty of Medicine, Monash University, Clayton, VIC, Australia
| | | | - Lawrence Lin
- Faculty of Medicine, Monash University, Clayton, VIC, Australia
| | - Michael Wang
- Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Christopher Chew
- Department of Dermatology, Alfred Health, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Clayton, VIC, Australia
| |
Collapse
|
2
|
Peirano D, Donoso F, Vargas S, Hidalgo L, Agüero R, Uribe P, Mondaca S, Navarrete-Dechent C. Patterns of Recurrence of Cutaneous Melanoma: A Literature Review. Dermatol Pract Concept 2023; 13:dpc.1304a304. [PMID: 37992344 PMCID: PMC10656145 DOI: 10.5826/dpc.1304a304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
The incidence of melanoma has been dramatically increasing over the last decades. Melanoma is considered to have a high metastatic potential and it can progress via lymphatic vessels or through hematogenous metastasis. Different patterns of recurrence have been described, namely, local, satellite, and in transit metastasis (LCIT), lymphatic metastasis, and systemic metastasis. With a more advanced melanoma stage at diagnosis, there is a higher risk for systemic metastasis in comparison to LCIT; in contrast, early-stage melanoma tends to recur more frequently as LCIT and less commonly as systematic metastasis. The aim of this review was to summarize the patterns of recurrence of cuta-neous melanoma, giving the clinician a practical summary for diagnosis, prognosis, and surveillance. There is a knowledge gap of the common patterns of recurrence that needs to be addressed to better identify patients at high risk of disease recurrence and personalize surveillance strategies as well as patient counseling.
Collapse
Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rosario Agüero
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastían Mondaca
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Medical Oncology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
3
|
Keller J, Stern S, Chang SC, Marcus R, Weiss J, Nassoiy S, Christopher W, Fischer T, Essner R. Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound. Ann Surg Oncol 2022; 29:8469-8477. [PMID: 35989390 DOI: 10.1245/s10434-022-12345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Multicenter Selective Lymphadenectomy Trial II (MSLT-II) led to a change in the management of tumor-positive sentinel lymph nodes (SLNs) from completion node dissection (CLND) to nodal observation. This study aimed to evaluate prognostic factors for predicting sentinel node basin recurrence (SNBR) using data from MSLT-II trial participants. METHODS In MSLT-II, 1076 patients were treated with observation. Patients were included in the current study if they had undergone a post-sentinel node basin ultrasound (PSNB-US) within 4 months after surgery. The study excluded patients with positive SLN by reverse transcription-polymerase chain reaction (RT-PCR) or incomplete SLN pathologic data. Primary tumor, patient, PSNB-US, and SLN characteristics were evaluated. Multivariable regression analyses were performed to determine independent prognostic factors associated with SNBR. RESULTS The study enrolled 737 patients: 193 (26.2%) patients with SNBR and 73 (9.9%) patients with first abnormal US. The patients with an abnormal first US were more likely to experience SNBR (23.8 vs. 5.0%). In the multivariable analyses, increased risk of SNBR was associated with male gender (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.00-1.9; p = 0.049), increasing Breslow thickness (aHR, 1.10; 95% CI, 1.01-1.2; p = 0.038), presence of ulceration (aHR, 1.93; 95% CI, 1.42-2.6; p < 0.001), sentinel node tumor burden greater than 1 mm (aHR, 1.91; 95% CI, 1.10-3.3; p = 0.022), lymphovascular invasion (aHR, 1.53; 95% CI, 1.00-2.3; p = 0.048), and presence of abnormal PSNB-US (aHR, 4.29; 95% CI, 3.02-6.1; p < 0.001). CONCLUSIONS The first postoperative US together with clinical and pathologic factors may play an important role in predicting SNBR.
Collapse
Affiliation(s)
- Jennifer Keller
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Stacey Stern
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | | | - Rebecca Marcus
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Jessica Weiss
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Sean Nassoiy
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | | | - Trevan Fischer
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Richard Essner
- Providence Saint John's Cancer Institute, Santa Monica, CA, USA.
| |
Collapse
|
4
|
Vale L, Kunonga P, Coughlan D, Kontogiannis V, Astin M, Beyer F, Richmond C, Wilson D, Bajwa D, Javanbakht M, Bryant A, Akor W, Craig D, Lovat P, Labus M, Nasr B, Cunliffe T, Hinde H, Shawgi M, Saleh D, Royle P, Steward P, Lucas R, Ellis R. Optimal surveillance strategies for patients with stage 1 cutaneous melanoma post primary tumour excision: three systematic reviews and an economic model. Health Technol Assess 2021; 25:1-178. [PMID: 34792018 DOI: 10.3310/hta25640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Malignant melanoma is the fifth most common cancer in the UK, with rates continuing to rise, resulting in considerable burden to patients and the NHS. OBJECTIVES The objectives were to evaluate the effectiveness and cost-effectiveness of current and alternative follow-up strategies for stage IA and IB melanoma. REVIEW METHODS Three systematic reviews were conducted. (1) The effectiveness of surveillance strategies. Outcomes were detection of new primaries, recurrences, metastases and survival. Risk of bias was assessed using the Cochrane Collaboration's Risk-of-Bias 2.0 tool. (2) Prediction models to stratify by risk of recurrence, metastases and survival. Model performance was assessed by study-reported measures of discrimination (e.g. D-statistic, Harrel's c-statistic), calibration (e.g. the Hosmer-Lemeshow 'goodness-of-fit' test) or overall performance (e.g. Brier score, R 2). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). (3) Diagnostic test accuracy of fine-needle biopsy and ultrasonography. Outcomes were detection of new primaries, recurrences, metastases and overall survival. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Review data and data from elsewhere were used to model the cost-effectiveness of alternative surveillance strategies and the value of further research. RESULTS (1) The surveillance review included one randomised controlled trial. There was no evidence of a difference in new primary or recurrence detected (risk ratio 0.75, 95% confidence interval 0.43 to 1.31). Risk of bias was considered to be of some concern. Certainty of the evidence was low. (2) Eleven risk prediction models were identified. Discrimination measures were reported for six models, with the area under the operating curve ranging from 0.59 to 0.88. Three models reported calibration measures, with coefficients of ≥ 0.88. Overall performance was reported by two models. In one, the Brier score was slightly better than the American Joint Committee on Cancer scheme score. The other reported an R 2 of 0.47 (95% confidence interval 0.45 to 0.49). All studies were judged to have a high risk of bias. (3) The diagnostic test accuracy review identified two studies. One study considered fine-needle biopsy and the other considered ultrasonography. The sensitivity and specificity for fine-needle biopsy were 0.94 (95% confidence interval 0.90 to 0.97) and 0.95 (95% confidence interval 0.90 to 0.97), respectively. For ultrasonography, sensitivity and specificity were 1.00 (95% confidence interval 0.03 to 1.00) and 0.99 (95% confidence interval 0.96 to 0.99), respectively. For the reference standards and flow and timing domains, the risk of bias was rated as being high for both studies. The cost-effectiveness results suggest that, over a lifetime, less intensive surveillance than recommended by the National Institute for Health and Care Excellence might be worthwhile. There was considerable uncertainty. Improving the diagnostic performance of cancer nurse specialists and introducing a risk prediction tool could be promising. Further research on transition probabilities between different stages of melanoma and on improving diagnostic accuracy would be of most value. LIMITATIONS Overall, few data of limited quality were available, and these related to earlier versions of the American Joint Committee on Cancer staging. Consequently, there was considerable uncertainty in the economic evaluation. CONCLUSIONS Despite adoption of rigorous methods, too few data are available to justify changes to the National Institute for Health and Care Excellence recommendations on surveillance. However, alternative strategies warrant further research, specifically on improving estimates of incidence, progression of recurrent disease; diagnostic accuracy and health-related quality of life; developing and evaluating risk stratification tools; and understanding patient preferences. STUDY REGISTRATION This study is registered as PROSPERO CRD42018086784. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 25, No. 64. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patience Kunonga
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Diarmuid Coughlan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Margaret Astin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dor Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dalvir Bajwa
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mehdi Javanbakht
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Wanwuri Akor
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Penny Lovat
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Labus
- Business Development and Enterprise, Newcastle University, Newcastle upon Tyne, UK
| | - Batoul Nasr
- Dermatological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Timothy Cunliffe
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Helena Hinde
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Mohamed Shawgi
- Radiology Department, James Cook University Hospital, Middlesbrough, UK
| | - Daniel Saleh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pam Royle
- Patient representative, ITV Tyne Tees, Gateshead, UK
| | - Paul Steward
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Rachel Lucas
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Robert Ellis
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK.,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| |
Collapse
|
5
|
Wang J, Ben Z, Gao S, Lyu S, Wei X. The role of ultrasound elastography and virtual touch tissue imaging in the personalized prediction of lymph node metastasis of breast cancer. Gland Surg 2021; 10:1460-1469. [PMID: 33968697 DOI: 10.21037/gs-21-199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study examined the effects of different ultrasound imaging technologies in the identification and prediction of axillary lymph node metastasis of breast cancer. It also investigated the relationship between human papilloma virus (HPV) infection and axillary lymph node metastasis. Methods Eighty-five female patients diagnosed with breast masses participated in this study. Each patient underwent a conventional ultrasound, ultrasonic elastography, and virtual touch tissue imaging quantification (VTIQ). The differential diagnosis efficiency of a conventional ultrasound, ultrasound elastography, VTIQ, and ultrasound elastography combined with VTIQ technology was compared with a pathological diagnosis, which represents the gold standard. 85 axillary lymph node tissues and 25 normal breast tissues were used to detect HPV positive infection rate differences in different tissues. Results The results showed that metastatic lymph nodes and reactive lymph node hyperplasia accounted for 54.12% and 45.88% of the 85 axillary lymph nodes of breast cancer, respectively. The conventional ultrasound, ultrasound elastography, and VTIQ scores of metastatic lymph nodes were significantly higher than those of reactive lymph node hyperplasia (P<0.05). The diagnostic sensitivity (Se) (91.30%), specificity (Sp) (92.31%), accuracy (Ac) (91.76%), positive predictive value (PPV) (93.33%), and negative predictive value (NPV) (90.00%) of ultrasound elastography combined with VTIQ technology were the highest among the diagnostic efficiency test results of different computer ultrasound imaging technologies. The positive infection rate of HPV in metastatic lymph node tissues was significantly higher than that in reactive lymph node hyperplasia and normal breast tissues (P<0.05). Conclusions Combining ultrasound elastography with VTIQ technology has high value in the differential diagnosis of axillary lymph nodes of breast cancer. Further, it appears that HPV infection may have an etiological role in lymph node metastasis in breast cancer patients.
Collapse
Affiliation(s)
- Jue Wang
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhifei Ben
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shanshan Gao
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuyi Lyu
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiuzhi Wei
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| |
Collapse
|
6
|
Howard MD. Melanoma Radiological Surveillance: A Review of Current Evidence and Clinical Challenges. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:207-213. [PMID: 32226349 PMCID: PMC7087071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melanoma is a common cancer in both young and older populations in many western countries. Rates of melanoma diagnosis worldwide are increasing. With the introduction of both targeted and immunotherapies there have been dramatic improvements in the care of patients with metastatic melanoma. With these new therapies being increasingly offered to patients with stage III metastatic melanoma and stage IV disease, radiological surveillance of melanoma has become a widely used method of monitoring melanoma patients for early locoregional and distant metastasis. However, concerns have been raised about risk of false positive results, which patients to consider radiological surveillance for, and at what intervals to do so. To date, there are no published review articles on the topic of radiological surveillance in melanoma patients identified in the MEDLINE database. A comprehensive literature review was performed by searching the MEDLINE database to review all published works on this topic. This article aims to present an extensive review of literature surrounding radiological surveillance in melanoma patients, a discussion of controversies, and recommendations for surveillance modalities.
Collapse
Affiliation(s)
- Matthew David Howard
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Dermatology, Monash Health, Clayton, Victoria, Australia
| |
Collapse
|