The role of ultrasound of sentinel nodes in the pre- and post-operative evaluation of stage I melanoma patients.

We have investigated the role of high-resolution ultrasound (US) in the analysis of sentinel node(s) in melanoma patients in pre-operative staging and follow-up. One hundred and six lymph node basins in 88 melanoma patients undergoing sentinel node biopsy (SNB) were examined: 25 (23.6%) were US positive for metastases and 81 (76.4%) were negative. Subsequent histological analysis of the 81 negative lymph nodes confirmed the absence of metastases in 80 cases (98.8%), whereas, in the 25 US-positive lymph nodes, metastases were found in 16 cases (64%). The follow-up of all patients submitted to SNB in our unit included a US investigation of operated and contralateral nodal basins every 4 months for the first 3 years and then every 6 months. Of a total of 300 patients, four (1.6%) were found to have locoregional nodal disease during follow-up. In three of these four patients, US was crucial in indicating the presence of nodal metastases, which would have gone undetected on physical examination. The result of this study (negative predictive value of 98.7%) introduces the possibility of selecting patients who may avoid an SNB procedure based on the results of pre-operative US examination.

Measurement by multidetector CT scan of the volume of hypopharyngeal and laryngeal tumours: accuracy and reproducibility.

The purpose of this study was to register the accuracy and reproducibility of the multidetector computed tomography (MDCT) estimate of hypopharyngeal and laryngeal tumor volumes. Eighteen consecutive patients with larynx or hypopharynx squamous cell carcinoma were enrolled in this prospective trial, scheduled for surgery and examined by MDCT. A total of 72 tumor volume measurements were reported by two different operators, one of them in three different sessions, using the sum-of-areas method. The results were compared with the volume calculated by surgical sampling. The mean tumor volume measured by MDCT was 5.7 +/- 9.3 ml (range 0.1-41.6). The mean volume measured from the surgical specimens was 5.6 +/- 8.6 ml (range 0.06-33.6). The level of agreement between histological and MDCT volumes was high, with a slight tendency of MDCT to overestimation, proportional to the size. The analysis of interoperator variability showed a tendency of the more expert operator to make more accurate estimates, but the differences were not significant (P = 0.62, 0.75 and 0.63). The evaluation of the three different sessions of the less expert operator revealed a good repeatability. According to our study, MDCT estimate of tumor volume is an effective, reproducible method. MDCT tends to produce more dispersed results in case of large tumors.

[Factors affecting the results of ultrasound-guided percutaneous biopsy in oncology].

PURPOSE: Cytological or histological sampling of a neoplastic lesion, suspect or non-suspect for malignancy, either primary or metastatic, is always mandatory for indicating and planning the therapeutic work-up. Ultrasound-guided percutaneous needle biopsy is the most used technique for obtaining cellular or tissue samples, as it is quick, easy, reliable and less expensive than other techniques. The aim of this paper is to evaluate the efficacy of US-guided biopsy in responding to the clinical query with a diagnostic result, and to analyse the different factors that might influence the diagnostic adequacy of the sampled cellular or tissue material. MATERIALS AND METHODS: The results of 1897 biopsies (either cytological or histological), obtained by percutaneous US guided technique in patients with a lesion suspect for neoplasm, were evaluated in terms of adequacy or inadequacy in obtaining a pathologic diagnosis. The results were analysed with regard to the site of the lesion, the sampling method (cytological or histological) and the expertise of the operator (in terms of number of formerly executed procedures). RESULTS: The difference in adequacy of histological vs cytological sampling resulted statistically significant (94.l63% vs 71.18%, p<0.00001). The operator's former experience resulted the most important factor in determining the success of the procedure. The operators with an experience rate below 50 former procedure have, in fact, obtained inadequate material more than twice (36.29% vs 15.9%) compared to the more experienced operators: the difference was statistically significant for histological samplings. CONCLUSIONS: The period of technical learning of operators may be considered adequate after a personal experience of almost 50 procedures learning or over for microhistological sampling; while the apprenticeship is continuous and progressive for optimisation of sampling by cytoaspiration.

Percutaneous placement of peritoneal port-catheter in oncologic patients.

The aim of this paper is to describe the technique of percutaneous ultrasound (US)-guided placement of a peritoneal port-catheter in an interventional radiological setting. Nineteen patients with peritoneal carcinomatosis were selected for intraperitoneal port-catheter placement in order to perform intracavitary receptor-immuno- or radio-immunotherapy with Ytrium-90. All the procedures were performed percutaneously under US and fluoro guidance; the insertion site for catheters was chosen according to abdominal conditions and US findings: all devices were implanted at the lower abdominal quadrants. All patients were followed up with CT and US according to the therapy protocol. The procedure was successfully completed in 15/19 patients, in 4 being contraindicated by peritoneal adhesions. No procedure-related complications and device occlusions during therapy were observed; one catheter displaced 7 months later the placement. In our experience, this procedure was feasible, reliable and easy to perform, allowing the correct administration of the planned intracavitary therapy. Peritoneal adhesions are the main limitation of peritoneal port placement.