Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we belie...Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. Design: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. Setting: Dermatology and radiology departments of a university hospital. Patients: A total of 160 new consecutive patients with stage I to stage III melanoma. Intervention: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. Main Outcome Measures: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. Results: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval 95% CI , 29.6-53.5) and 76.9% (95% CI, 66.7% -87.2% ) (P < .001)and specificity was 95.7% (95% CI, 93.5% -97.9% ) and 98.4% (95% CI, 97.1% -99.8% ) (P < .05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% 95% CI, 82.5-89.9 ) (P < .05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. Conclusion: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.展开更多
Objective: To assess the efficacy of 5%imiquimod cream on undifferentiated vulvar intraepithelial neoplasia (VIN), a disease caused by high-risk human papillomavirus. Design: Prospective, uncontrolled study. Setting: ...Objective: To assess the efficacy of 5%imiquimod cream on undifferentiated vulvar intraepithelial neoplasia (VIN), a disease caused by high-risk human papillomavirus. Design: Prospective, uncontrolled study. Setting: University hospital vulvar clinic. Patients: Twelve consecutive patients treated with 5%imiquimod cream for undifferentiated VIN between March 1, 1999, and May 31, 2001. Intervention: Self-application of 5%imiquimod cream, initially 3 times a week, then adjusted according to tolerance, for up to 7 months according to clinical response. Main Outcome Measures: Therapeutic response, clinically assessed by successive photographs and histologically confirmed for complete responders, was scored as complete, partial (≥50%decrease in lesion size), or failure. Tolerance was evaluated at each visit. Results: A total of 3, 4, and 5 patients achieved complete response, partial response (≥75%reduction in lesion size for all such cases), and failure, respectively. Mean duration of treatment was 3.6 months (37.3 applications), 5.0 months (50.7 applications), and 3.4 months (25.2 applications) for complete responders, partial responders, and failures, respectively. Follow-up after treatment was 5 to 18, 14 to 32, and 2 to 28 months, respectively, with 1 partial responder lost to long-term follow-up. No patient developed invasive carcinoma. All but 2 patients experienced vulvar discomfort, resulting in treatment withdrawal for 3. Two patients had flulike symptoms. Conclusions: Imiquimod cream could be a therapeutic option for undifferentiated VIN. Although poorly tolerated, this self-applied treatment could spare patients, either totally or partially, the classic painful and sometimesmutilating treatments of VIN. Controlled, randomized studies are needed to evaluate its efficacy and tolerance.展开更多
文摘Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. Design: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. Setting: Dermatology and radiology departments of a university hospital. Patients: A total of 160 new consecutive patients with stage I to stage III melanoma. Intervention: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. Main Outcome Measures: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. Results: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval 95% CI , 29.6-53.5) and 76.9% (95% CI, 66.7% -87.2% ) (P < .001)and specificity was 95.7% (95% CI, 93.5% -97.9% ) and 98.4% (95% CI, 97.1% -99.8% ) (P < .05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% 95% CI, 82.5-89.9 ) (P < .05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. Conclusion: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.
文摘Objective: To assess the efficacy of 5%imiquimod cream on undifferentiated vulvar intraepithelial neoplasia (VIN), a disease caused by high-risk human papillomavirus. Design: Prospective, uncontrolled study. Setting: University hospital vulvar clinic. Patients: Twelve consecutive patients treated with 5%imiquimod cream for undifferentiated VIN between March 1, 1999, and May 31, 2001. Intervention: Self-application of 5%imiquimod cream, initially 3 times a week, then adjusted according to tolerance, for up to 7 months according to clinical response. Main Outcome Measures: Therapeutic response, clinically assessed by successive photographs and histologically confirmed for complete responders, was scored as complete, partial (≥50%decrease in lesion size), or failure. Tolerance was evaluated at each visit. Results: A total of 3, 4, and 5 patients achieved complete response, partial response (≥75%reduction in lesion size for all such cases), and failure, respectively. Mean duration of treatment was 3.6 months (37.3 applications), 5.0 months (50.7 applications), and 3.4 months (25.2 applications) for complete responders, partial responders, and failures, respectively. Follow-up after treatment was 5 to 18, 14 to 32, and 2 to 28 months, respectively, with 1 partial responder lost to long-term follow-up. No patient developed invasive carcinoma. All but 2 patients experienced vulvar discomfort, resulting in treatment withdrawal for 3. Two patients had flulike symptoms. Conclusions: Imiquimod cream could be a therapeutic option for undifferentiated VIN. Although poorly tolerated, this self-applied treatment could spare patients, either totally or partially, the classic painful and sometimesmutilating treatments of VIN. Controlled, randomized studies are needed to evaluate its efficacy and tolerance.
