Table 1.

The Shields index to predict metastatic potential of cutaneous melanoma.

Authors	Sample size	Design	Epitumoral lymphatic vessel density method	Outcome
Shields et al. (7)	21	Retrospective	Complete • All lymphatics counted • x40 objective • 350 µm from tumor edge	Index predicted metastasis more effectively than thickness alone
Emmett et al. (4)	102	Retrospective	Complete and hotspot • x100 objective • Three areas of subjectively high density were counted and averaged	Hotspot faster but comparable to complete method Shields index (81% specific, 82% sensitive) predicted metastasis more effectively than lymphatic vessel density and AJCC staging
Spiric et al. (11)	100	Retrospective	Hotspot	Shields index (75% specific, 81.3% sensitive), performed better at predicting metastasis than thickness and AJCC staging