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Melanoma Metastases in Regional Lymph Nodes Are Accurately Detected by Proton Magnetic Resonance Spectroscopy of Fine-Needle Aspirate Biopsy Samples

¹ Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia
² Department of Surgery, University of Sydney, Camperdown, New South Wales 2006, Australia
³ Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Avenue, Winnipeg, Manitoba R3B 1Y6, Canada Manitoba Canada
⁴ Institute for Magnetic Resonance Research and Department of Magnetic Resonance in Medicine, University of Sydney, Block 3, Level 3, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia
⁵ Department of Anatomical Pathology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia

Correspondence: Address correspondence and reprint requests to: Cynthia L. Lean, PhD; E-mail: cynth{at}imrr.usyd.edu.au.

Background: Nonsurgical assessment of sentinel nodes (SNs) would offer advantages over surgical SN excision by reducing morbidity and costs. Proton magnetic resonance spectroscopy (MRS) of fine-needle aspirate biopsy (FNAB) specimens identifies melanoma lymph node metastases. This study was undertaken to determine the accuracy of the MRS method and thereby establish a basis for the future development of a nonsurgical technique for assessing SNs.

Methods: FNAB samples were obtained from 118 biopsy specimens from 77 patients during SN biopsy and regional lymphadenectomy. The specimens were histologically evaluated and correlated with MRS data. Histopathologic analysis established that 56 specimens contained metastatic melanoma and that 62 specimens were benign. A linear discriminant analysis–based classifier was developed for benign tissues and metastases.

Results: The presence of metastatic melanoma in lymph nodes was predicted with a sensitivity of 92.9%, a specificity of 90.3%, and an accuracy of 91.5% in a primary data set. In a second data set that used FNAB samples separate from the original tissue samples, melanoma metastases were predicted with a sensitivity of 87.5%, a specificity of 90.3%, and an accuracy of 89.1%, thus supporting the reproducibility of the method.

Conclusions: Proton MRS of FNAB samples may provide a robust and accurate diagnosis of metastatic disease in the regional lymph nodes of melanoma patients. These data indicate the potential for SN staging of melanoma without surgical biopsy and histopathological evaluation.

Key Words: Melanoma • Lymph node metastases • Magnetic resonance spectroscopy • Cancer • Statistical classification strategy

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