Hypothesis: The diagnostic yield of chest radiography; computed tomography (CT) of the chest, abdomen, and pelvis; and CT or magnetic resonance imaging of the brain in the initial evaluation of melanoma with metastasis to sentinel lymph nodes may not identify systemic disease.
Design: Retrospective analysis.
Setting: Tertiary care referral center.
Patients: Of 1183 patients identified from a database of individuals who underwent selective sentinel lymphadenectomy for primary melanoma (Breslow thickness, 0.2-30 mm), we studied 185 with at least 1 sentinel lymph node positive for metastatic melanoma (Breslow thickness, 0.8-14.5 mm).
Interventions: Chest radiography; CT of the chest, abdomen, and pelvis; and CT or magnetic resonance imaging of the brain after selective sentinel lymphadenectomy with positive sentinel lymph nodes. The medical records of the 185 patients were systematically reviewed by 4 physician reviewers, and data were extracted primarily from pathology and radiology reports. When medical records were unavailable, information was taken from formal clinic and inpatient progress notes.
Main outcome measure: Diagnostic yield of imaging studies.
Results: The results of 0.5% of the imaging studies were positive for metastatic disease, 86% were negative, and 14% were indeterminate. Indeterminate results were confirmed to be negative by additional studies ranging from repeated imaging to invasive procedures, including thoracotomy and brain biopsy. The yields are as follows: chest radiography, 0%; chest CT, 0.7%; abdominal and pelvic CT, 0.7%; brain CT, 0%; and brain magnetic resonance imaging, 0%. Only 1 patient (0.5%) had detectable metastatic disease, and he had symptoms of systemic disease at the time of imaging.
Conclusions: Computed tomography of the chest, abdomen and pelvis, and brain rarely reveals systemic metastasis at the time of selective sentinel lymphadenectomy. Routine imaging of asymptomatic patients at the time of selective sentinel lymphadenectomy is not indicated.