Evaluation of Radiological Procedures to Detect the ...



Evaluation of Radiological Procedures to Detect the Inguinal Lymph Node Metastasis in Skin Carcinomas: A Comparison of CT, MRI and Ultrasound Sonography

Hideyuki Tada, Mitsuo Hatoko, Aya Tanaka, Satoshi Yurugi, Hiroshi Iioka, Katsunori Niitsuma

In skin carcinomas, malignant melanoma, squamous cell carcinoma, and Paget carcinoma may produce lymph node metastasis and distal metastasis. Preoperative and postoperative prudent observation is necessary for the treatment of these tumors. In order to grasp the existence of metastasis quickly, the existence of lymph node swelling must be evaluated periodically. We adapted palpation, CT, MRI, and ultrasound sonography to evaluate the lymph node swelling. We have also determined the indication of lymph node dissection by these procedures. We compared the results of these procedures with those of a postoperative histopathological examination, and the reliability of these radiological procedures was evaluated.

(Materials and Methods) We evaluated the 21 cases that was performed lymph node dissection in our department for the last five years. The subjects of the evaluation were 13 cases of malignant melanomas, 4 cases of squamous cell carcinoma, and 4 cases of Paget carcinoma, and dissected regions were 14 cases of inguinal region, 5 cases of axillar region, and 2 cases of cervical region. In order to determine the indication of lymph node dissection, palpation, CT, MRI, and the ultrasound sonography were performed to evaluate the condition of lymph nodes, and comparative study of these results and those of histopathological examination was carried out.

(Results) The probability which the preoperative evaluation and postoperative histopathological result were corresponded, was palpation: 76.２%, CT: 85.８%, MRI: 85.８%, and ultrasound sonography: 100%(Table 1).

(Conclusion) This evaluation indicated that the ultrasound sonography brought the most reliable results. It was possible to observe the blood flow to lymphocytes and the conditions of surrounding lymph gates with ultrasound sonography. These benefits enabled us to diagnose that the swelling lymph nodes were either inflammatory or metastatic. From these results, it was thought that ultrasound sonography was the most useful procedure to evaluate the lymph node swelling in the treatment of skin carcinomas.

Table. 1

　Case　 diagnosis　　　　dissection　palpation　MRI CT US　pathology

1 Malignant melanoma　　inguinal 　　＋ − − − −

2 Paget carcinoma　　　　inguinal　　 ＋　　 ＋　　＋　　＋　　 ＋

3 Squamous cell carcinoma inguinal　　 ＋　　 ＋ ＋ ＋ ＋

4 Malignant melanoma　　neck　　　　＋　　 ＋　　＋　　＋　　 ＋

5 Paget carcinoma inguinal ＋　 −　 ＋　 −　　 −

6 Malignant melanoma　　axilla − − − − −

7 Squamous cell carcinoma axilla − − − − −

8 Paget carcinoma inguinal ＋ ＋ ＋ ＋ ＋

9 Malignant melanoma　　 inguinal ＋ ＋ ＋ ＋ ＋

10 Malignant melanoma　　 axilla ＋ ＋ ＋ ＋ ＋

11 Malignant melanoma　　 axilla − − ＋ ＋ ＋

12Squamous cell carcinoma inguinal ＋ ＋ ＋ ＋ ＋

13 Malignant melanoma　　 inguinal ＋ − ＋ ＋ ＋

14 Malignant melanoma　　 inguinal ＋ ＋ ＋ ＋ ＋

　 15 Malignant melanoma　 　inguinal　　 ＋　　 ＋　　＋　　＋　 　＋

　 16Squamous cell carcinoma neck ＋ ＋ ＋ ＋ ＋

　 17 Malignant melanoma　　 inguinal − − ＋ − −

18 Malignant melanoma　 　inguinal ＋ ＋ ＋ ＋ ＋

19 Paget carcinoma inguinal − 　 ＋　　＋　 ＋　　 ＋

20 Malignant melanoma　　 inguinal　　 − − − ＋ ＋

21 Malignant melanoma　　 inguinal ＋ ＋ ＋ ＋ ＋

Table 2

Palpation MRI CT US

True positive 13 13 15 16

True negative 3 5 3 5

False positive 2 0 2 0

False negative 3 3 1 0

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