RESUMO
BACKGROUND: Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment. OBJECTIVES: a) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness. MATERIALS AND METHODS: Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed. RESULTS: The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (P>.05). The sensitivity of ultrasound for the diagnosis of MM over 1mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively. CONCLUSIONS: Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.
Assuntos
Melanoma/diagnóstico por imagem , Melanoma/patologia , Cuidados Pré-Operatórios/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia/métodos , Melanoma Maligno CutâneoRESUMO
Introducción: El espesor tumoral es una variable de gran trascendencia en el manejo clínico del melanoma maligno cutáneo (MMC), ya que no solo establece el pronóstico, sino que además determina la planificación de márgenes quirúrgicos y selecciona a aquellos pacientes candidatos a biopsia selectiva de ganglio centinela. El índice de Breslow (IB) es el procedimiento histométrico estándar para la determinación del espesor tumoral del melanoma. El desarrollo de técnicas de imagen, como la ecografía cutánea (EC), plantea la posibilidad de realizar una estimación no invasiva que agiliza la instauración del tratamiento definitivo. Objetivos: a) Evaluar la EC como instrumento de medición del espesor tumoral en el MMC, y b) analizar los factores histológicos que influyen en la estimación del espesor ecográfico. Material y métodos: Estudio retrospectivo de una serie consecutiva de 79 melanomas cutáneos primarios. En todos los casos, se practicó un estudio ecográfico preoperatorio con una sonda de 15 Mhz para la determinación del espesor tumoral (EE). Se analizaron los exámenes histológicos, estudiándose el IB, además de la presencia de ulceración, regresión, infiltrado inflamatorio y nevus. Se estudian el grado de correlación y el nivel de concordancia entre los valores de EE e IB. Se estiman la sensibilidad, la especificidad y los valores predictivos de la EC en el diagnóstico de melanomas de espesor >1mm. Se analiza la relación de las variables histológicas en la determinación del EE. Resultados: Se estudian 79 melanomas primarios, IB medio: 0,8mm (DE: 1,4). La EC evidenció un grado de correlación y un nivel de concordancia moderado con respecto al IB (coeficiente de correlación de Pearson: 0,678, coeficiente de correlación intraclase: 0,78, respectivamente). La EC mostró tendencia a sobrestimar el espesor histológico en relación con la presencia de infiltrado inflamatorio moderado-intenso y nevus, sin alcanzar significación estadística (p>0,05). La EC mostró valores de sensibilidad y especificidad, y valores predictivos positivo y negativo para el diagnóstico de melanomas gruesos (>1mm) del 82, el 80, el 54 y el 94%, respectivamente. Conclusión: La EC permite discriminar con bastante precisión melanomas finos y planificar márgenes quirúrgicos adecuados, pero presenta limitaciones para el diagnóstico de melanomas gruesos. Son necesarios más estudios para confirmar si determinadas características histológicas del tumor, como la presencia de infiltrado inflamatorio moderado-intenso y nevus, pueden condicionar una sobrestimación del espesor ecográfico, limitando su aplicabilidad clínica en el manejo del MMC (AU)
Background: Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment. Objectives: a) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness. Materials and methods: Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed. Results: The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was non significantly related to the presence of a moderate to intense infiltrate and associated nevi (P>0.05). The sensitivity of ultrasound for the diagnosis of MM over 1mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively. Conclusions: Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management (AU)
Assuntos
Humanos , Masculino , Feminino , Melanoma/patologia , Melanoma , Prognóstico , Sensibilidade e Especificidade , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Ultrassonografia , Melanoma/classificação , Melanoma/fisiopatologia , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
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