Journal Article

Interdisciplinary Implementation of a Synoptic Reporting Template for Melanoma Nodal Surveillance Ultrasound

Galgano, Samuel J., Burgan, Constantine M., Montgomery, Kelsey B., Holder, Ashley M., Duncan, Zoey N., Broman, Kristy K.

2024

Overview

Background With nodal surveillance increasingly used for sentinel lymph node-positive (SLN+) melanoma following the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), high-quality nodal ultrasonography (U/S) has become a critical need. Previous work has demonstrated low utilization of MSLT-II U/S criteria to define abnormal lymph nodes requiring intervention or biopsy. To address this gap, an evidence-based synoptic template was designed and implemented in this single-center study. Methods Sentinel lymph node-positive patients undergoing nodal surveillance at a tertiary cancer center from July 2017 to June 2023 were identified retrospectively. Ultrasound reporting language was analyzed for MSLT-II criteria reported and clinically actionable recommendations (e.g., normal, abnormal with recommendation for biopsy). Following a multidisciplinary design process, the synoptic template was implemented in January 2023. Postimplementation outcomes were evaluated by using U/S reports and provider surveys. Results A total of 337 U/S studies were performed on 94 SLN+ patients, with a median of 3 U/S per patient (range 1–12). Among 42 synoptic-eligible U/S performed postimplementation, 32 U/S (76.0%) were reported synoptically. Significant increases were seen in the number of MSLT-II criteria reported (Pre 0.5 ± 0.8 vs. Post 2.5 ± 1.0, p < 0.001), and clinically actionable recommendations for abnormal findings (Pre 64.0% vs. Post 93.0%, p = 0.04). Nearly all surgeon and radiologist survey respondents were “very” or “completely” satisfied with the clinical utility of the synoptic template (90.0%). Conclusions Following implementation of a synoptic template, U/S reports were significantly more likely to document MSLT-II criteria and provide an actionable recommendation, increasing usefulness to providers. Efforts to disseminate this synoptic template to other centers are ongoing.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Biopsy / Female / Follow-Up Studies / Humans / Lymph Node Excision / Lymph nodes / Lymph Nodes - diagnostic imaging / Lymph Nodes - pathology / Lymph Nodes - surgery / Lymphatic Metastasis / Lymphatic system / Male / Medicine / Medicine & Public Health / Melanoma / Melanoma - diagnostic imaging / Melanoma - pathology / Melanoma - surgery / Middle Aged / Oncology / Prognosis / Retrospective Studies / Sentinel Lymph Node - diagnostic imaging / Sentinel Lymph Node - pathology / Sentinel Lymph Node - surgery / Sentinel Lymph Node Biopsy - methods / Skin Neoplasms - diagnostic imaging / Skin Neoplasms - pathology / Skin Neoplasms - surgery / Surgery / Surgical Oncology / Surveillance / Surveys / Ultrasonic imaging / Ultrasonography - methods / Ultrasound