Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. / Valor de la ecografía ganglionar previa a la biopsia del ganglio centinela en 384 pacientes con melanoma: análisis de coste-efectividad.

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.

[Eating behavior, body attitudes and psychopathology in morbid obesity]. / Conductas alimentarias, actitudes hacia el cuerpo y psicopatología en obesidad mórbida.

INTRODUCTION: Obesity is an ever more frequent health problem. An assessment of eating habits, attitudes towards the body and presence and degree of psychopathology in morbid obese subjects is presented. METHOD: Eighty subjects with morbid obesity (BMI > 40), candidates for bariatric surgery, were systematically studied. A semistructured interview was carried out, including demographic and anthropometric data, eating habits, family history of obesity and family and personal background of psychiatric illness. The following tests were also administered: BITE, EDI and GHQ-28. RESULTS: Most of the subjects were women (90%), married (67.5%), with medium educational and professional levels. Mean age was 38 years, weight 131.3 kg, and BMI 50.17 kg/m2. A high frequency of familial history of obesity (82.5%) was observed, with fewer familial antecedents of depression (37.5%) and personal history of psychiatric illness (36.3%). A total of 27.5% admitted binge eating, 60% were nibblers and 46.3% sweet eaters. BITE results shows a medium level of bulimia (12.25), with 22.5% high scorers. A high level of body dissatisfaction (mean score of 21.5), with a significant drive for thinness stood out in the EDI. GHQ detects the existence of psychopathology in low degree (mean total score of 8.64), especially anxiety-insomnia, with a high proportion of possible psychopathologic disorders (46.2%). CONCLUSIONS: Morbid obese subjects have a significant frequency of binge eating, and show a high level of body dissatisfaction, an important drive for thinness and medium frequency of low degree psychopathology, mainly anxiety.