Original Article
Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma
Evaluación de la ecografía cutánea de 15 Mhz en la estimación preoperatoria del espesor tumoral en el melanoma maligno
I. Fernández Canedoa,
, M. de Troya Martína, R. Fúnez Liébanab, F. Rivas Ruizc, G. Blanco Egurend, N. Blázquez Sáncheza
Autor para correspondencia
a Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
b Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain
c Unidad de Investigación, Hospital Costa del Sol, Marbella, Málaga, Spain
d Servicio de Radiología, Hospital Costa del Sol, Marbella, Málaga, Spain
Leído
7018
Vecesse ha leído el artículo
2608
Total PDF
4410
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S157821901300036X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.025" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "678" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:227-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2374 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 1658 "PDF" => 670 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731012003055" "issn" => "00017310" "doi" => "10.1016/j.ad.2012.06.007" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "678" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:227-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2521 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 1873 "PDF" => 644 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Evaluación de la ecografía cutánea de 15 Mhz en la estimación preoperatoria del espesor tumoral en el melanoma maligno" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "227" "paginaFinal" => "231" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1337 "Ancho" => 1628 "Tamanyo" => 100757 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Gráfico de dispersión entre el espesor tumoral histológico y ecográfico.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Fernández Canedo, M. de Troya Martín, R. Fúnez Liébana, F. Rivas Ruiz, G. Blanco Eguren, N. Blázquez Sánchez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Fernández Canedo" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "de Troya Martín" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Fúnez Liébana" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Rivas Ruiz" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Blanco Eguren" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Blázquez Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901300036X" "doi" => "10.1016/j.adengl.2012.06.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300036X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012003055?idApp=UINPBA000044" "url" => "/00017310/0000010400000003/v1_201304241344/S0001731012003055/v1_201304241344/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013000371" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.10.008" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "764" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:232-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3662 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 2625 "PDF" => 994 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prevalence of Antiphospholipid Antibodies in Patients With Subacute and Chronic Cutaneous Lupus Erythematosus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "232" "paginaFinal" => "238" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de anticuerpos antifosfolipido en pacientes con lupus eritematoso cutáneo subagudo y crónico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2170 "Ancho" => 3170 "Tamanyo" => 350440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm. Abbreviations: CLE indicates cutaneous lupus erythematosus; SLE, systemic lupus erythematosus; ANA, antinuclear antibodies; aPTT, activated partial thromboplastin time; LA, lupus anticoagulant; ACA, anticardiolipin antibodies; anti-β<span class="elsevierStyleInf">2</span>GPI, anti-β<span class="elsevierStyleInf">2</span>-glycoprotein I; APS, antiphospholipid syndrome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. García-Martín, C. García-García, J. Fraga, A. García-Díez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "García-Martín" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "García-García" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Fraga" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "García-Díez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101200539X" "doi" => "10.1016/j.ad.2012.10.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101200539X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000371?idApp=UINPBA000044" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000371/v1_201304241622/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219013000358" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.024" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "674" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:220-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3504 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 2938 "PDF" => 509 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Clinical Presentation of Acral Lentiginous Melanoma: A Descriptive Study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "220" "paginaFinal" => "226" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio descriptivo de la presentación clínica del melanoma lentiginoso acral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Pereda, V. Traves, C. Requena, C. Serra-Guillén, B. Llombart, O. Sanmartín, C. Guillén, E. Nagore" "autores" => array:8 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Pereda" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Traves" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Requena" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Serra-Guillén" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Llombart" ] 5 => array:2 [ "nombre" => "O." "apellidos" => "Sanmartín" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Guillén" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Nagore" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012003018" "doi" => "10.1016/j.ad.2012.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012003018?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000358?idApp=UINPBA000044" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000358/v1_201304241622/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Preoperative 15-MHz Ultrasound Assessment of Tumor Thickness in Malignant Melanoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "227" "paginaFinal" => "231" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Fernández Canedo, M. de Troya Martín, R. Fúnez Liébana, F. Rivas Ruiz, G. Blanco Eguren, N. Blázquez Sánchez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Fernández Canedo" "email" => array:1 [ 0 => "inesbier@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "de Troya Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Fúnez Liébana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Rivas Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "G." "apellidos" => "Blanco Eguren" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "N." "apellidos" => "Blázquez Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Investigación, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la ecografía cutánea de 15 Mhz en la estimación preoperatoria del espesor tumoral en el melanoma maligno" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 2167 "Tamanyo" => 180325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ultrasound and histologic assessment of tumor thickness.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tumor thickness is of great importance in the management of cutaneous malignant melanoma because it is used to determine the prognosis and is a key factor in planning surgical margins and selecting candidates for sentinel node biopsy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Breslow depth is the standard measure of tumor thickness in primary cutaneous melanoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A histologic measurement, Breslow depth requires a preoperative excisional skin biopsy and, in addition to being invasive, the procedure may delay definitive surgical treatment because it involves a 2-stage intervention.Cutaneous ultrasound is a noninvasive imaging technique for visualizing the interior layers of the skin. The use of this tool in the field of dermatology has been studied in recent years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although the majority of early studies used 20-MHz probes capable of measuring lesions at a depth of 6 to 8<span class="elsevierStyleHsp" style=""></span>mm, many others used lower-resolution probes (10-15<span class="elsevierStyleHsp" style=""></span>MHz) because these were available in most hospitals. However, the current trend is to use higher-resolution probes (75-100<span class="elsevierStyleHsp" style=""></span>MHz), which measure lesions confined to the epidermis and dermis more accurately. In cutaneous malignant melanoma, cutaneous ultrasound offers the possibility of estimating tumor thickness in vivo, thus avoiding excisional biopsy and speeding up surgical treatment planning.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Results of recent studies of the validity and utility of cutaneous ultrasound in the management of cutaneous malignant melanoma have been inconsistent.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate cutaneous ultrasound as a tool for measuring tumor thickness in cutaneous malignant melanoma. The histologic variables that affect ultrasound assessment of tumor thickness are also analyzed.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This retrospective study evaluated the records of a consecutive series of patients with cutaneous malignant melanomas who underwent surgery between 2008 and 2010 in the dermatology department of the Hospital Costa del Sol. In all cases, members of the hospital's radiology department had performed a preoperative assessment of the lesion using a Toshiba Aplio XG 15-Mhz ultrasound probe to determine tumor thickness. Tumor thickness had been calculated automatically as the maximum vertical distance from the entry echo to the lowest hypoechoic signal, expressed in mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The histologic measure of thickness (Breslow depth) had been determined by a pathologist experienced in dermatopathology using an ocular micrometer to measure the maximum distance between the highest level of the stratum granulosum of the epidermis and the deepest point of the tumor, expressed in mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The histologic presence of ulceration, regression (absent, < 50%, > 50%), inflammatory infiltrate (absent, mild, moderate, severe), and associated nevi had also been recorded.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The study was approved by the ethics committee of Hospital Costa del Sol.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">We compared the ultrasound measurement of tumor thickness against the results obtained with the gold standard method (Breslow depth), using the Pearson correlation coefficient and the intraclass correlation coefficient to quantify the degree of correlation and agreement between the 2 variables. To study the association between histologic variables (ulceration, regression, inflammatory infiltrate, and presence of nevi) and ultrasound assessment of thickness, bivariate analysis was performed, taking as the dependent variable the overestimation of thickness by ultrasound (+ 0.1<span class="elsevierStyleHsp" style=""></span>mm) compared with Breslow depth, using χ<span class="elsevierStyleSup">2</span> tests and, where appropriate, the Fisher exact test. Statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05. Finally, we studied the sensitivity, specificity, and positive and negative predictive values of cutaneous ultrasound against those of the gold standard for the correct classification of thick melanomas (Breslow depth > 1<span class="elsevierStyleHsp" style=""></span>mm) with a 95% CI.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">We studied 79 melanomas from 79 patients (53% of them women) with a mean (SD) age of 56.8 (16.2) years; 42% were located on the trunk, 40% on the limbs, and 18% on the head and neck. Melanomas in situ accounted for 45% of the tumors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>35) and the remaining 55% were invasive tumors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44; 27 melanomas ≤ 1<span class="elsevierStyleHsp" style=""></span>mm, 17 melanomas > 1<span class="elsevierStyleHsp" style=""></span>mm). The mean Breslow depth of the series was 0.8 (1.4) mm. The mean thickness as measured by ultrasound was 1.2 (1.7) mm. The histologic findings are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The Pearson correlation coefficient between ultrasound assessment of thickness and Breslow depth was 0.678 (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The value of the intraclass correlation coefficient measuring agreement between the ultrasound assessment of thickness and Breslow depth was 0.78 (95% CI, 0.61-0.88).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Bivariate analysis showed that ultrasound tended to overestimate tumor thickness in the presence of moderate to severe inflammatory infiltrate and nevi, though this tendency was not statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Classic sensitivity tests showed that the sensitivity of ultrasound for the diagnosis of thick melanomas (Breslow depth > 1<span class="elsevierStyleHsp" style=""></span>mm) was 82%, specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">In this study we analyzed the accuracy of cutaneous ultrasound as a tool for measuring tumor thickness in a consecutive series of 79 primary melanomas. Of interest is the high proportion of minimally invasive melanomas in situ, a finding that we attribute to the systematic use of dermoscopy in the diagnosis of pigmented skin lesions and to the continuous application of primary prevention strategies in our population.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We found moderate correlation and agreement between ultrasound and histologic measures, whereas most earlier studies<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–10</span></a> have reported good correlation. Tacke et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> using a 20-MHz probe on a series of 259 melanomas, reported a correlation coefficient of 0.88 (lesions of 0.55 to 0.95<span class="elsevierStyleHsp" style=""></span>mm were classified incorrectly by ultrasound in 34% of cases and lesions of 1.30 to 1.70<span class="elsevierStyleHsp" style=""></span>mm were classified incorrectly in 50% of cases). Conversely, Serrone et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> using a 20-MHz probe on a series of 261 lesions, reported a correlation coefficient of 0.95 in melanomas larger than 1.51<span class="elsevierStyleHsp" style=""></span>mm, finding the lowest correlation in lesions smaller than 0.75<span class="elsevierStyleHsp" style=""></span>mm. The results reported by Kaikaris et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> using a 14-MHz probe, were similar (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.283 in melanomas of 1–2<span class="elsevierStyleHsp" style=""></span>mm and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.869 in melanomas larger than 2<span class="elsevierStyleHsp" style=""></span>mm). Many factors make comparison between studies difficult, including the use of diverse probes, differences between the series studied, the inclusion of benign lesions (mainly nevi),<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and the exclusion of in situ lesions<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in the belief that ultrasound does not visualize epidermal lesions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Some histologic features of tumors may alter the ultrasound assessment of thickness.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Hoffman et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found that the cause of 80% of cases of overestimation was the presence of inflammatory infiltrate. In our series, cutaneous ultrasound tended to overestimate tumor thickness in comparison with the histologic measure in the presence of moderate to severe inflammatory infiltrate and associated nevi, though no statistical significance was found (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05). These histologic features act as artifacts and interfere with the ultrasound assessment of the tumor because cutaneous ultrasound does not differentiate between tumor cells and inflammatory or nevus cells.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The sensitivity, specificity, and positive and negative predictive values for the diagnosis of thick melanomas (>1<span class="elsevierStyleHsp" style=""></span>mm) were 82%, 80%, 54%, and 94%, respectively. These results suggest that cutaneous ultrasound would properly stage the tumor and allow a single surgical intervention to be planned in approximately 80% of melanomas. However, it would not provide an accurate measurement on which to base a therapeutic decision in 20% of melanomas. Cutaneous ultrasound showed high discriminatory capacity for thin melanomas but was less successful at discriminating thick melanomas. Some authors have developed diagnostic algorithms that increase the diagnostic accuracy for thick melanomas by combining clinical, dermoscopic, and ultrasound findings, reaching a sensitivity of 97% and a specificity of 100%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Almost half the melanomas assessed by ultrasound as thick were in fact thin (< 1<span class="elsevierStyleHsp" style=""></span>mm). This finding is explained by the frequent association of inflammatory infiltrate and nevi with the melanomas in our series. This tendency towards overestimation can be remedied by using higher-frequency probes, which have a higher resolution.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The results of one study, in line with our findings, showed a particularly good correspondence between ultrasound and histologic measurements using a 30-MHz probe when the lesions were smaller than 1<span class="elsevierStyleHsp" style=""></span>mm in a series of 68 melanomas and an even better correspondence in lesions on the sole (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.945).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In contrast, Machet et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> using a 20-MHz probe, found lesions on the sole to be difficult to measure because of the thickness of the stratum corneum.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the ultrasound estimation of tumor thickness our results contrast with those published in a recent prospective study of 54 cutaneous malignant melanomas, which reported sensitivity, specificity, and positive and negative predictive values in the diagnosis of thick melanomas (> 1<span class="elsevierStyleHsp" style=""></span>mm) of 86%, 97%, 95%, and 91%, respectively.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The diagnostic accuracy of cutaneous ultrasound in that study was striking despite the lower ultrasound resolution of the probe used by the authors (10 Mhz). These results could be explained by the high proportion of melanomas later found to be thick on histology, which would be more accurately measured by ultrasound assessment because the presence of other histologic factors would not alter their ultrasound assessment as thick melanomas.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The present study had several limitations. The small size of our series made it difficult to interpret the results with regard to the influence of histologic findings on the ultrasound assessment of thickness, so it was not possible to establish causal relationships between histologic and ultrasound findings. Interpersonal variability may interfere in the ultrasound assessment of tumor thickness, though the use of standardized procedure minimizes this bias.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Technological advances in ultrasound, such as the use of contrast agents,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and the incorporation of new in vivo microscopy techniques, including dermoscopy<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> and confocal microscopy,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> are encouraging and their combined use will improve the preoperative diagnosis of melanoma in the near future.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion, cutaneous ultrasound is a tool of great interest in the preoperative study of cutaneous malignant melanoma. It identifies thin melanomas fairly accurately and can be useful for planning appropriate surgical margins. Further studies are necessary to confirm whether certain histologic characteristics of the tumor, such as the presence of moderate to severe inflammatory infiltrate and associated nevi, can lead to an overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in the management of cutaneous malignant melanoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical Considerations</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of persons and animals</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors state that no experiments on humans or animals were performed in this study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Data confidentiality</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres97873" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objectives" 3 => "Materials and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec85029" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres97872" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivos" 3 => "Material y métodos" 4 => "Resultados" 5 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec85028" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical Considerations" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] ] ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-01-16" "fechaAceptado" => "2012-06-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec85029" "palabras" => array:3 [ 0 => "Cutaneous ultrasound" 1 => "Tumour thickness" 2 => "Melanoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec85028" "palabras" => array:3 [ 0 => "Ecografía cutánea" 1 => "Espesor tumoral" 2 => "Melanoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">a)</span> To evaluate the utility of ultrasound assessment of tumor thickness in MM, and <span class="elsevierStyleItalic">b)</span> to analyze histologic variables that affect ultrasound assessments of thickness.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1<span class="elsevierStyleHsp" style=""></span>mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05). The sensitivity of ultrasound for the diagnosis of MM over 1<span class="elsevierStyleHsp" style=""></span>mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El espesor tumoral es una variable de gran trascendencia en el manejo clínico del melanoma maligno cutáneo (MMC), ya que no solo establece el pronóstico, sino que además determina la planificación de márgenes quirúrgicos y selecciona a aquellos pacientes candidatos a biopsia selectiva de ganglio centinela. El índice de Breslow (IB) es el procedimiento histométrico estándar para la determinación del espesor tumoral del melanoma. El desarrollo de técnicas de imagen, como la ecografía cutánea (EC), plantea la posibilidad de realizar una estimación no invasiva que agiliza la instauración del tratamiento definitivo.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">a)</span> Evaluar la EC como instrumento de medición del espesor tumoral en el MMC, y <span class="elsevierStyleItalic">b)</span> analizar los factores histológicos que influyen en la estimación del espesor ecográfico.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de una serie consecutiva de 79 melanomas cutáneos primarios. En todos los casos, se practicó un estudio ecográfico preoperatorio con una sonda de 15 Mhz para la determinación del espesor tumoral (EE). Se analizaron los exámenes histológicos, estudiándose el IB, además de la presencia de ulceración, regresión, infiltrado inflamatorio y nevus. Se estudian el grado de correlación y el nivel de concordancia entre los valores de EE e IB. Se estiman la sensibilidad, la especificidad y los valores predictivos de la EC en el diagnóstico de melanomas de espesor ><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm. Se analiza la relación de las variables histológicas en la determinación del EE.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se estudian 79 melanomas primarios, IB medio: 0.8<span class="elsevierStyleHsp" style=""></span>mm (DE: 1,4). La EC evidenció un grado de correlación y un nivel de concordancia moderado con respecto al IB (coeficiente de correlación de Pearson: 0.678, coeficiente de correlación intraclase: 0.78, respectivamente). La EC mostró tendencia a sobrestimar el espesor histológico en relación con la presencia de infiltrado inflamatorio moderado-intenso y nevus, sin alcanzar significación estadística (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). La EC mostró valores de sensibilidad y especificidad, y valores predictivos positivo y negativo para el diagnóstico de melanomas gruesos (><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm) del 82, el 80, el 54 y el 94%, respectivamente.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La EC permite discriminar con bastante precisión melanomas finos y planificar márgenes quirúrgicos adecuados, pero presenta limitaciones para el diagnóstico de melanomas gruesos. Son necesarios más estudios para confirmar si determinadas características histológicas del tumor, como la presencia de infiltrado inflamatorio moderado-intenso y nevus, pueden condicionar una sobrestimación del espesor ecográfico, limitando su aplicabilidad clínica en el manejo del MMC.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Fernández Canedo I, et al. Evaluación de la ecografía cutánea de 15 Mhz en la estimación preoperatoria del espesor tumoral en el melanoma maligno. Actas Dermosifiliogr. 2013;104:227–31.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 2167 "Tamanyo" => 180325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ultrasound and histologic assessment of tumor thickness.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1340 "Ancho" => 1632 "Tamanyo" => 114314 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Scatter plot of histologic and ultrasound assessment of tumor thickness.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Histology(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">In Situ (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">≤<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">>1<span class="elsevierStyleHsp" style=""></span>mm (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ulceration: yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regression:<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory infiltrate: moderate-intense \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Associated nevus: yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183312.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Histologic Characteristics of the Melanomas.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No Overestimation</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Overestimation (+ 0.1 mm)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Regression</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>< 50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>> 50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ulceration</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Inflammatory infiltrate</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absent-mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate-severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Associated nevus</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183311.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Relationship of Ultrasound Assessment of Thickness and Histological Variables.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Histology</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">≤<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ultrasound</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183313.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Histologic and Ultrasound Assessment of Thickness of the Series of 79 Melanomas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revised U. K. Guidelines for the Management of Cutaneous Melanoma 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.R. Marsden" 1 => "J.A. Newton-Bishop" 2 => "L. Burrows" 3 => "M. Cook" 4 => "P.G. Corrie" 5 => "N.H. Cox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2010.09883.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2010" "volumen" => "163" "paginaInicial" => "238" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20608932" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thickness, cross sectional areas and depth of invasion in the prognosis of malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Breslow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1970" "volumen" => "172" "paginaInicial" => "902" "paginaFinal" => "908" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5477666" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound scanning in dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.H. Schmid-Wendtner" 1 => "W. Burgdorf" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatology" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "217" "paginaFinal" => "224" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current technologies in vivo diagnosis of cutaneous melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.Q. Wang" 1 => "H. Rabinovitz" 2 => "A.W. Kopf" 3 => "M. Oliviero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2003.12.008" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2004" "volumen" => "22" "paginaInicial" => "217" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15262307" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of ultrasound in patients with melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.F. Uren" 1 => "A. Sanki" 2 => "J.F. Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1586/14737140.7.11.1633" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Anticancer Ther" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "1633" "paginaFinal" => "1642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18020929" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical relevance of sonometry-derived tumor thickness in malignant melanoma: a statistical analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Tacke" 1 => "G. Haagen" 2 => "O.P. Hornstein" 3 => "G. Huettinger" 4 => "F. Kieserwetter" 5 => "H. Schell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1995" "volumen" => "132" "paginaInicial" => "209" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7888357" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High frequency ultrasound in the preoperative staging of primary melanoma: a statistical analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Serrone" 1 => "F.M. Solivetti" 2 => "M.F. Thorel" 3 => "L. Eibenshutz" 4 => "P. Donati" 5 => "C. Catricalá" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Melanoma Res" "fecha" => "2002" "volumen" => "12" "paginaInicial" => "287" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140386" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement of melanoma thickness -<span class="elsevierStyleHsp" style=""></span>- comparison of two methods: ultrasound versus morphology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Kaikaris" 1 => "D. Samsanavicius" 2 => "K. Maslauskas" 3 => "R. Rimdeika" 4 => "S. Valiukeviciene" 5 => "J. Makstiene" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Plastic Reconst Aesthet Surg" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "796" "paginaFinal" => "802" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limitations of high frequency ultrasound in determining the invasiveness of cutaneous malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Partsch" 1 => "M. Binder" 2 => "M. Püspök Schwarz" 3 => "K. Wolff" 4 => "H. Pehamberger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Melanoma Res" "fecha" => "1996" "volumen" => "6" "paginaInicial" => "395" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8908600" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does high frequency (40-60 Mhz) ultrasound imaging play a role in the clinical management of cutaneous melanoma?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Semple" 1 => "A.K. Gupta" 2 => "L. From" 3 => "K.A. Harasiewicz" 4 => "D. Sauder" 5 => "F.S. Foster" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Plastic Surg" "fecha" => "1995" "volumen" => "34" "paginaInicial" => "599" "paginaFinal" => "605" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant melanoma in 20<span class="elsevierStyleHsp" style=""></span>MHz B scan sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Hoffman" 1 => "J. Jung" 2 => "S. el-Gammal" 3 => "P. Altmeyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "1992" "volumen" => "185" "paginaInicial" => "49" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1638071" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative melanoma thickness determination by 20<span class="elsevierStyleHsp" style=""></span>MHz sonography and digital videomicroscopy in combination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Pellacani" 1 => "S. Seidenari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2003" "volumen" => "139" "paginaInicial" => "293" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12622620" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Guitera" 1 => "L.X. Li" 2 => "K. Crotty" 3 => "P. FitzGerald" 4 => "R. Mellenbergh" 5 => "G. Pellacani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08681.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2008" "volumen" => "159" "paginaInicial" => "364" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18565186" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High frequency 30 Mhz sonography in preoperative assessment of tumor thickness of primary melanoma: usefulness in determination of surgical margin and indication for sentinel lymph node biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Hayasi" 1 => "H. Koga" 2 => "H. Uhara" 3 => "T. Saida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10147-009-0894-3" "Revista" => array:6 [ "tituloSerie" => "Int J Clin Oncol" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "426" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19856051" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative measurement of thickness of cutaneous melanoma using high-resolution 20 MHZ ultrasound imaging: monocenter prospective study and systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Machet" 1 => "V. Belot" 2 => "M. Naouri" 3 => "M. Boka" 4 => "Y. Mourtada" 5 => "B. Giraudeau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ultrasmedbio.2009.03.018" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Med Biol" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "1411" "paginaFinal" => "1420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19616369" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative assessment of cutaneous melanoma thickness using 10<span class="elsevierStyleHsp" style=""></span>MHz sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Vilana" 1 => "S. Puig" 2 => "M. Sánchez" 3 => "M. Squarcia" 4 => "A. Lopez" 5 => "T. Castel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.08.1387" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "2009" "volumen" => "193" "paginaInicial" => "639" "paginaFinal" => "643" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19696275" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and dermoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Argenziano" 1 => "G. Fabbrocini" 2 => "P. Carli" 3 => "V. de Giorgi" 4 => "M. Delfino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "40" "paginaInicial" => "61" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9922013" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative assessment of melanoma thickness by ABCD score of dermatoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Carli" 1 => "V. De Giorgi" 2 => "M. Palli" 3 => "V. Giannotti" 4 => "B. Giannotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.106518" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "459" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10954657" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Confocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.G.B. Langley" 1 => "M. Rajadhyasksha" 2 => "P.J. Dwyer" 3 => "A.J. Sober" 4 => "T.J. Flotte" 5 => "R. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2001.117395" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2001" "volumen" => "45" "paginaInicial" => "365" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11511832" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S157821901300036X/v1_201304241622/en/main.assets" "Apartado" => array:4 [ "identificador" => "6155" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000003/v1_201304241622/S157821901300036X/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300036X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 8 | 15 |
| 2024 Octubre | 63 | 42 | 105 |
| 2024 Septiembre | 74 | 34 | 108 |
| 2024 Agosto | 95 | 68 | 163 |
| 2024 Julio | 75 | 40 | 115 |
| 2024 Junio | 96 | 37 | 133 |
| 2024 Mayo | 68 | 30 | 98 |
| 2024 Abril | 78 | 35 | 113 |
| 2024 Marzo | 69 | 26 | 95 |
| 2024 Febrero | 59 | 26 | 85 |
| 2024 Enero | 73 | 46 | 119 |
| 2023 Diciembre | 43 | 33 | 76 |
| 2023 Noviembre | 68 | 35 | 103 |
| 2023 Octubre | 79 | 48 | 127 |
| 2023 Septiembre | 64 | 36 | 100 |
| 2023 Agosto | 37 | 23 | 60 |
| 2023 Julio | 53 | 45 | 98 |
| 2023 Junio | 49 | 31 | 80 |
| 2023 Mayo | 38 | 25 | 63 |
| 2023 Abril | 38 | 22 | 60 |
| 2023 Marzo | 46 | 28 | 74 |
| 2023 Febrero | 52 | 29 | 81 |
| 2023 Enero | 38 | 34 | 72 |
| 2022 Diciembre | 55 | 38 | 93 |
| 2022 Noviembre | 38 | 31 | 69 |
| 2022 Octubre | 32 | 43 | 75 |
| 2022 Septiembre | 36 | 48 | 84 |
| 2022 Agosto | 41 | 38 | 79 |
| 2022 Julio | 31 | 45 | 76 |
| 2022 Junio | 31 | 26 | 57 |
| 2022 Mayo | 38 | 47 | 85 |
| 2022 Abril | 41 | 40 | 81 |
| 2022 Marzo | 58 | 61 | 119 |
| 2022 Febrero | 36 | 27 | 63 |
| 2022 Enero | 40 | 43 | 83 |
| 2021 Diciembre | 34 | 39 | 73 |
| 2021 Noviembre | 37 | 38 | 75 |
| 2021 Octubre | 66 | 60 | 126 |
| 2021 Septiembre | 44 | 47 | 91 |
| 2021 Agosto | 35 | 35 | 70 |
| 2021 Julio | 34 | 38 | 72 |
| 2021 Junio | 32 | 31 | 63 |
| 2021 Mayo | 39 | 39 | 78 |
| 2021 Abril | 107 | 90 | 197 |
| 2021 Marzo | 60 | 25 | 85 |
| 2021 Febrero | 55 | 29 | 84 |
| 2021 Enero | 34 | 21 | 55 |
| 2020 Diciembre | 39 | 14 | 53 |
| 2020 Noviembre | 28 | 19 | 47 |
| 2020 Octubre | 29 | 13 | 42 |
| 2020 Septiembre | 38 | 9 | 47 |
| 2020 Agosto | 18 | 21 | 39 |
| 2020 Julio | 34 | 17 | 51 |
| 2020 Junio | 36 | 28 | 64 |
| 2020 Mayo | 36 | 16 | 52 |
| 2020 Abril | 38 | 23 | 61 |
| 2020 Marzo | 40 | 17 | 57 |
| 2020 Febrero | 0 | 1 | 1 |
| 2020 Enero | 0 | 3 | 3 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 1 | 1 | 2 |
| 2019 Septiembre | 10 | 0 | 10 |
| 2019 Julio | 0 | 7 | 7 |
| 2019 Junio | 0 | 9 | 9 |
| 2019 Mayo | 3 | 34 | 37 |
| 2019 Abril | 0 | 22 | 22 |
| 2019 Marzo | 0 | 9 | 9 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 0 | 4 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 35 | 7 | 42 |
| 2018 Enero | 29 | 11 | 40 |
| 2017 Diciembre | 48 | 10 | 58 |
| 2017 Noviembre | 45 | 11 | 56 |
| 2017 Octubre | 42 | 10 | 52 |
| 2017 Septiembre | 19 | 7 | 26 |
| 2017 Agosto | 31 | 6 | 37 |
| 2017 Julio | 32 | 14 | 46 |
| 2017 Junio | 56 | 21 | 77 |
| 2017 Mayo | 51 | 13 | 64 |
| 2017 Abril | 45 | 20 | 65 |
| 2017 Marzo | 45 | 24 | 69 |
| 2017 Febrero | 22 | 10 | 32 |
| 2017 Enero | 57 | 11 | 68 |
| 2016 Diciembre | 54 | 8 | 62 |
| 2016 Noviembre | 46 | 12 | 58 |
| 2016 Octubre | 65 | 10 | 75 |
| 2016 Septiembre | 50 | 17 | 67 |
| 2016 Agosto | 54 | 13 | 67 |
| 2016 Julio | 31 | 16 | 47 |
| 2016 Junio | 7 | 13 | 20 |
| 2016 Mayo | 9 | 17 | 26 |
| 2016 Abril | 7 | 2 | 9 |
| 2016 Marzo | 6 | 3 | 9 |
| 2016 Febrero | 4 | 1 | 5 |
| 2016 Enero | 11 | 3 | 14 |
| 2015 Diciembre | 6 | 0 | 6 |
| 2015 Noviembre | 11 | 1 | 12 |
| 2015 Octubre | 7 | 1 | 8 |
| 2015 Septiembre | 8 | 1 | 9 |
| 2015 Agosto | 9 | 1 | 10 |
| 2015 Julio | 68 | 119 | 187 |
| 2015 Junio | 68 | 11 | 79 |
| 2015 Mayo | 82 | 31 | 113 |
| 2015 Abril | 61 | 17 | 78 |
| 2015 Marzo | 28 | 1 | 29 |
| 2015 Febrero | 20 | 4 | 24 |
| 2015 Enero | 14 | 2 | 16 |
| 2014 Diciembre | 26 | 5 | 31 |
| 2014 Noviembre | 14 | 5 | 19 |
| 2014 Octubre | 24 | 2 | 26 |
| 2014 Septiembre | 16 | 1 | 17 |
| 2014 Agosto | 17 | 6 | 23 |
| 2014 Julio | 21 | 3 | 24 |
| 2014 Junio | 24 | 2 | 26 |
| 2014 Mayo | 22 | 6 | 28 |
| 2014 Abril | 31 | 5 | 36 |
| 2014 Marzo | 26 | 9 | 35 |
| 2014 Febrero | 19 | 4 | 23 |
| 2014 Enero | 18 | 5 | 23 |
| 2013 Diciembre | 27 | 12 | 39 |
| 2013 Noviembre | 23 | 4 | 27 |
| 2013 Octubre | 23 | 8 | 31 |
| 2013 Septiembre | 5 | 3 | 8 |
| 2013 Agosto | 8 | 2 | 10 |
| 2013 Julio | 3 | 2 | 5 |
| 2013 Junio | 2 | 6 | 8 |
| 2013 Mayo | 0 | 2 | 2 |
| 2013 Abril | 2 | 2 | 4 |
Mostrar todo
