Ultrasound Surveillance in Melanoma Management: Bridging Diagnostic Promise with Real-World Adherence: A Systematic Review and Meta-Analysis

IF 8.6 1区 医学 Q1 DERMATOLOGY
Zhao Feng Liu, Amy Sylivris, Johnny Wu, Darren Tan, Samuel Hong, Lawrence Lin, Michael Wang, Christopher Chew
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引用次数: 0

Abstract

Background

Ultrasound surveillance has become the new standard of care in stage III melanoma after the 2017 Multicenter Selective Lymphadenectomy Trial II (MSLT-II) demonstrated non-inferior 3-year survival compared with complete lymph node dissection.

Objective

We aimed to quantify diagnostic performance and adherence rates of ultrasound surveillance for melanoma locoregional metastasis, offering insights into real-world applicability.

Methods

Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched the Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases from inception until 11 October 2023. All primary studies that reported data on the diagnostic performance or adherence rates to ultrasound surveillance in melanoma were included. R statistical software was used for data synthesis and analysis. Sensitivity and specificity were aggregated across studies using the meta-analytic method for diagnostic tests outlined by Rutter and Gatsonis. Adherence rates were calculated as the ratio of patients fully compliant to planned follow-up to those who were not.

Results

A total of 36 studies including 18,273 patients were analysed, with a mean age of 56.6 years and a male-to-female ratio of 1:1.11. The median follow-up duration and frequency was 36 and 4 months, respectively. The pooled sensitivity of ultrasound examination was 0.879 (95% confidence interval [CI] 0.878–0.879) and specificity was 0.969 (95% CI 0.968–0.970), representing a diagnostic odds ratio of 224.5 (95% CI 223.1–225.9). Ultrasound examination demonstrated a substantial improvement in absolute sensitivity over clinical examination alone, with a number needed to screen (NNS) of 2.95. The overall adherence rate was 77.0% (95% CI 76.0–78.1%), with significantly lower rates in the United States [US] (p <  0.001) and retrospective studies (p <  0.001).

Conclusion

Ultrasound is a powerful diagnostic tool for locoregional melanoma metastasis. However, the real applicability to surveillance programmes is limited by low adherence rates, especially in the US. Further studies should seek to address this adherence gap.

Abstract Image

Abstract Image

黑色素瘤管理中的超声监测:连接诊断承诺与现实世界的坚持:系统回顾与元分析
背景2017年多中心选择性淋巴结切除术试验II(MSLT-II)显示,与完全淋巴结清扫术相比,超声监测的3年生存率并不劣于完全淋巴结清扫术,因此超声监测已成为III期黑色素瘤治疗的新标准。方法 根据系统综述和元分析首选报告项目(PRISMA)指南,我们系统检索了 Medline、Embase、Cochrane Library、CINAHL、Scopus 和 Web of Science 数据库中从开始到 2023 年 10 月 11 日的所有研究。纳入了所有报告黑色素瘤超声监测诊断效果或坚持率数据的主要研究。使用 R 统计软件进行数据综合与分析。采用 Rutter 和 Gatsonis 概述的诊断测试荟萃分析方法对各研究的敏感性和特异性进行汇总。坚持率按完全按计划随访的患者与未按计划随访的患者之比计算。结果 共分析了 36 项研究,包括 18 273 名患者,平均年龄为 56.6 岁,男女比例为 1:1.11。随访时间和次数的中位数分别为 36 个月和 4 个月。超声检查的汇总灵敏度为 0.879(95% 置信区间 [CI] 0.878-0.879),特异性为 0.969(95% CI 0.968-0.970),诊断几率比为 224.5(95% CI 223.1-225.9)。与单纯的临床检查相比,超声检查大大提高了绝对灵敏度,筛查所需人数(NNS)为 2.95。总体坚持率为 77.0%(95% CI 76.0-78.1%),美国(US)和回顾性研究(P< 0.001)的坚持率明显较低(P< 0.001)。结论超声波是局部黑色素瘤转移的强大诊断工具,但由于使用率较低,特别是在美国,其在监测计划中的实际应用受到了限制。进一步的研究应设法解决这一问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
15.20
自引率
2.70%
发文量
84
审稿时长
>12 weeks
期刊介绍: The American Journal of Clinical Dermatology is dedicated to evidence-based therapy and effective patient management in dermatology. It publishes critical review articles and clinically focused original research covering comprehensive aspects of dermatological conditions. The journal enhances visibility and educational value through features like Key Points summaries, plain language summaries, and various digital elements, ensuring accessibility and depth for a diverse readership.
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