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Improved Differentiation of Benign and Malignant Lymphadenopathy in Patients With Cutaneous Melanoma by Contrast-Enhanced Color Doppler Sonography
Monika-Hildegard Schmid-Wendtner, MD;
Karin Partscht, MD;
Hans Christian Korting, MD;
Matthias Volkenandt, MD
Arch Dermatol. 2002;138:491-497.
Objective To evaluate whether administration of a D-galactose–based signal
enhancer is useful in color Doppler sonography (CDS) for better detection
of vascularity patterns, which may help to differentiate malignant from benign
lymph nodes in patients with cutaneous melanomas.
Design Comparison of B-mode sonography, native CDS, and signal-enhanced CDS.
Setting Department of Dermatology and Allergology, Ludwig-Maximilians-University,
Munich, Germany.
Patients Twenty examinations in 19 patients (median age, 60 years; 10 men) who
presented with echo-poor structures suggestive of lymphadenopathy in B-mode
sonography during follow-up for cutaneous melanomas.
Interventions Histopathologic and follow-up examinations; documentation by color prints.
Main Outcome Measures Frequency of detection and description of different lymph node vascularity
patterns in signal-enhanced CDS.
Results Signal-enhanced CDS revealed additional information about vascularization
of lymph node metastases, reactive lymph nodes, hematomas, and seromas, which
was helpful for the differential diagnosis in 15 of 20 examinations. For lymph
node metastases, signal enhancement facilitated the detection of accessory
peripheral vessels in most investigations. Concerning reactive lymph nodes,
hilar vessels in part with branching to the lymph node periphery could be
identified only after application of the contrast enhancer in most patients.
Quantitative variables could not be measured in all cases and did not help
to differentiate between malignant and reactive lymph nodes.
Conclusions Administration of a D-galactose–based signal enhancer for CDS
in patients with cutaneous melanomas can help to differentiate malignant from
reactive lymph nodes, hematomas, or seromas. However, these promising results
require confirmation in a prospective multicenter study.
From the Department of Dermatology and Allergology, Ludwig-Maximilians-University,
Munich, Germany.
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