Validity of ultrasound-guided aspiration needle biopsy in the diagnosis of micrometastases in sentinel lymph nodes in patients with cutaneous melanoma.

Background/Aim: Cutaneous melanoma is one of the most aggressive solid cancers, that develops local, regional and distant metastases. The presence of metastases in lymph nodes is in correlation with Breslow tumor thickness. According to various researches, in melanoma with more than 4 mm Breslow thickness, lymph node micrometastases can be found in 60-70% of cases. Sentinel lymph nodes biopsy is a diagnostic procedure for lymph node micrometastasis detection, which is necessary for disease staging. In recent studies, ultrasound-guided fine needle aspiration with cytology (US FNAC) of the sentinel lymph node was used as less invasive procedure, but is not accepted as the standard procedure. The goal of this work was to define sensitivity, specification and precision of the ultrasound-guided fine needle aspiration method in comparison with standard sentinel lymph node biopsy. Methods: After obtaining the Ethics Committee's permission, from 2012 to 2014 a total of 60 patients with cutaneous melanoma were enrolled, and divided into three groups: group I with thin melanoma, group II with intermediate thickness melanoma and group III with thick melanoma. The presence of micrometastases in sentinel regional lymph nodes was analyzed by US FNAC. The results obtained were compared to sentinel lymph nodes biopsy (SLNB) results. The golden standard for calculating the specific, sensitive and precise characteristics of the method of US FNAC of sentinel lymph nodes was histopathologic lymph node examination of sentinel lymph nodes acquired through biopsy. Results: Detection rate of US FNAC was 0% in the group I, 5% in the group II and 30% in the group III. SLNB detection rates were: 10% in the group I, 15% in the group II, and 45% in the group III. In melanoma thicker than 4 mm, 15% of the patients were false negative by US FNAC. The sensitivity of US FNAC for all the patients was 50%: in the group I, 0%; in the group II, 33.3%; and in the group III, 66.6%. The method specificity for all examined patients was 100% and accuracy 88%: group I, 90%; group II, 90%; group III, 85%. The FNAC and SLNB micrometastasis detection rate was significantly higher in melanoma with Breslow thickness > 4 mm (group 3) in comparison to thin and intermediate thickness tumors. Conclusion: The method of ultrasound-guided fine needle aspiration of sentinel lymph nodes, according to its sensitivity, has a place in the diagnostics of micrometastasis in regional lymph nodes only in thick melanoma, but not in thin and intermediary thickness melanoma. The results must be confirmed in a larger number of patients. If this observation could be confirmed, it would rationalize treatment of patients with thick melanoma, decrease the number of operations and shorten the time to make the diagnosis.

[Anatomic and histological characteristics of vagina reconstructed by McIndoe method].

BACKGROUND/AIM: Congenital absence of vagina is known from ancient times of Greek. According to the literature data, incidence is 1/4 000 to 1/20 000. Treatment of this anomaly includes non-operative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to establish anatomic and histological characteristics of vagina reconstructed by McIndoe method in Mayer Küster-Rockitansky Hauser (MKRH) syndrome and compare them with normal vagina. METHODS: The study included 21 patients of 18 and more years with congenital anomaly known as aplasio vaginae within the Mayer Küster-Rockitansky Hauser syndrome. The patients were operated on by the plastic surgeon using the McIndoe method. The study was a retrospective review of the data from the history of the disease, objective and gynecological examination and cytological analysis of native preparations of vaginal stain (Papanicolau). Comparatively, 21 females of 18 and more years with normal vaginas were also studed. All the subjects were divided into the groups R (reconstructed) and C (control) and the subgroups according to age up to 30 years (1 R, 1C), from 30 to 50 (2R, 2C), and over 50 (3R, 3C). Statistical data processing was performed by using the Student's t-test and Mann-Writney U-test. A value of p < 0.05 was considered statistically significant. RESULTS: The results show that there are differences in the depth and the wideness of reconstructed vagina, but the obtained values are still in the range of normal ones. Cytological differences between a reconstructed and the normal vagina were found. CONCLUSION: A reconstructed vagina is smaller than the normal one regarding depth and width, but within the range of normal values. A split skin graft used in the reconstruction, keeps its own cytological, i.e. histological and, so, biological characteristics.

[Sensibility of vagina reconstructed by McIndoe method in Mayer-Rokitansky-Küster-Hauser syndrome].

BACKGROUND/AIM: Congenital absence of vagina is a failure present in Mayer-Küster-Rokitansky-Hauser syndrome. Treatment of this anomaly includes nonoperative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to determine sensitivity (touch, warmness, coldness) of a vagina reconstructed by McIndoe method in Mayer-Küster-Rokitansky-Hauser syndrome and compare it with the normal vagina. METHODS: A total of 21 female persons with reconstructed vagina by McIndoe method and 21 female persons with normal vagina were observed. All female persons were devided into groups and subgroups (according to age). Sensibility to touch, warmness and coldness were examined, applying VonFrey's esthesiometer and termoesthesiometer for warmness and coldness in three regions of vagina (enter, middle wall, bothom). The number of positive answers was registrated by touching the mucosa regions for five seconds, five times. RESULTS: The obtained results showed that female patients with a reconstructed vagina by McIndoe method, felt touch at the middle part of wall and in the bottom of vagina better than patients with normal one. Also, the first ones felt warmness at the middle part of wall and coldness in the bottom of vagina, better than the patients with normal vagina. Other results showed no difference in sensibility between reconstructed and normal vagina. CONCLUSION: Various types of sensibility (touch, warmness, coldness) are better or the same in vaginas reconstructed by McIndoe method, in comparison with normal ones. This could be explaned by the fact that skin grafts are capable of recovering sensibility.