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• W2742470808 abstract "La ecografía ganglionar locorregional como parte de la estadificación previa a la biopsia del ganglio centinela (BSGC) en pacientes con melanoma no se incluye habitualmente en las guías de manejo. El objetivo de este estudio es evaluarla desde la perspectiva clínica y económica. Estudio retrospectivo de 384 pacientes con melanoma primario de estadios clínicos I-II, en el periodo 2004-2015, a los que se les realizó una ecografía ganglionar locorregional (±biopsia ecodirigida) previa a la BSGC. Se evaluó la fiabilidad de la técnica y se realizó un análisis de su coste efectividad. En 23 pacientes (6%) se pudo evitar la realización de la BSGC mediante la técnica. La ecografía mostró una sensibilidad del 46% y una especificidad del 76% para la detección de ganglios metastásicos clínicamente no palpables. Los falsos negativos fueron significativamente más frecuentes en pacientes mayores de 60 años y con tumores <2 mm. El coste unitario del proceso de estadificación mediante BSGC con ecografía-biopsia ecodirigida generó un sobrecoste de 16,30 €. El análisis coste-efectividad identificó como estrategia dominante desde ese punto de vista el protocolo de estadificación con ecografía y BSGC, con una ratio coste-efectividad inferior a la de la alternativa consistente en BSGC (8.095,24 vs. 28.605,00 €) La ecografía con biopsia ecodirigida como método diagnóstico de estadificación previo a la BSGC es una herramienta útil y coste-efectiva, que no sustituye a la BSGC, pero que permite en un porcentaje no desdeñable de casos evitar su realización. Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2 mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients." @default.
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• W2742470808 date "2017-12-01" @default.
• W2742470808 modified "2023-10-15" @default.
• W2742470808 title "Valor de la ecografía ganglionar previa a la biopsia del ganglio centinela en 384 pacientes con melanoma: análisis de coste-efectividad" @default.
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• W2742470808 doi "https://doi.org/10.1016/j.ad.2017.06.002" @default.
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