Advertisement

Direct comparison of [18F]FDG PET/CT with PET alone and with side-by-side PET and CT in patients with malignant melanoma

  • Felix M. MottaghyEmail author
  • Cord Sunderkötter
  • Roland Schubert
  • Petra Wohlfart
  • Norbert M. Blumstein
  • Bernd Neumaier
  • Gerhard Glatting
  • Cueneyt Özdemir
  • Andreas K. Buck
  • Karin Scharfetter-Kochanek
  • Sven N. Reske
Original article

Abstract

Purpose

The purpose of this retrospective, blinded study was to evaluate the additional value of [18F]FDG PET/CT in comparison with PET alone and with side-by-side PET and CT in patients with malignant melanoma (MM).

Methods

A total of 127 consecutive studies of patients with known MM referred for a whole-body PET/CT examination were included in this study. PET alone, side-by-side PET and CT and integrated PET/CT study were independently and separately interpreted without awareness of the clinical information. One score each was applied for certainty of lesion localisation and for certainty of lesion characterisation. Verification of the findings was subsequently performed using all available clinical, pathological (n = 30) and follow-up information.

Results

The number of lesions with an uncertain localisation was significantly (p < 0.001) reduced by PET/CT and side-by-side PET and CT (p < 0.05) in comparison with PET alone. In line with this increase in certainty integrated PET/CT reading also improved certainty in characterisation of lesions, however, this did not reach significance (p = 0.057) compared versus PET alone. Respectively, PET, side-by-side PET and CT and PET/CT showed a sensitivity of 86%, 89% and 91%, a specificity of 94%, 94% and 94%, a positive predictive value of 96%, 96% and 96% and a negative predictive value of 80%, 83% and 87%.

Conclusion

Integrated PET/CT offers a significant benefit in lesion localisation and an improvement in lesion characterisation compared with PET alone or with side-by-side PET and CT. The benefit is not as great as that reported for other tumour entities, which may be due to the high avidity of MM for [18F]FDG.

Keywords

[18F]FDG PET PET/CT Oncology Malignant melanoma 

References

  1. 1.
    Garbe C, Paul A, Kohler-Spath H, Ellwanger U, Stroebel W, Schwarz M, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003;21:520–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Morton DL, Wanek L, Nizze JA, Elashoff RM, Wong JH. Improved long-term survival after lymphadenectomy of melanoma metastatic to regional nodes. Analysis of prognostic factors in 1134 patients from the John Wayne Cancer Clinic. Ann Surg 1991;214:491–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Wood TF, DiFronzo LA, Rose DM, Haigh PI, Stern SL, Wanek L, et al. Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival? Ann Surg Oncol 2001;8:658–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Ollila DW, Hsueh EC, Stern SL, Morton DL. Metastasectomy for recurrent stage IV melanoma. J Surg Oncol 1999;71:209–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001;19:3635–48.PubMedGoogle Scholar
  6. 6.
    Stephens PL, Ariyan S, Ocampo RV, Poo WJ. The predictive value of lymphoscintigraphy for nodal metastases of cutaneous melanoma. Conn Med 1999;63:387–90.PubMedGoogle Scholar
  7. 7.
    Dicker TJ, Kavanagh GM, Herd RM, Ahmad T, McLaren KM, Chetty U, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999;140:249–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 1998;82:1664–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Holder WD Jr, White RL Jr, Zuger JH, Easton EJ Jr, Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998;227:764–9; discussion 769–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Eigtved A, Andersson AP, Dahlstrom K, Rabol A, Jensen M, Holm S, et al. Use of fluorine-18 fluorodeoxyglucose positron emission tomography in the detection of silent metastases from malignant melanoma. Eur J Nucl Med 2000;27:70–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Swetter SM, Carroll L, Johnson D, Segall G. Positron emission tomography (PET) is superior to computerized tomography (CT) for metastatic staging in melanoma patients. Clin Positron Imaging 2000;3:154.PubMedCrossRefGoogle Scholar
  12. 12.
    Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol 2002;9:646–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Harris MT, Berlangieri SU, Cebon JS, Davis ID, Scott AM. Impact of 2-deoxy-2[F-18]fluoro-D-glucose positron emission tomography on the management of patients with advanced melanoma. Mol Imaging Biol 2005;23:1–5.Google Scholar
  14. 14.
    Reinhardt MJ, Joe AY, Jaeger U, Huber A, Matthies A, Bucerius J, et al. Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N- and M-staging of malignant melanoma: experience with 250 consecutive patients. J Clin Oncol 2006;24:1178–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Mijnhout GS, Hoekstra OS, van Lingen A, van Diest PJ, Ader HJ, Lammertsma AA, et al. How morphometric analysis of metastatic load predicts the (un)usefulness of PET scanning: the case of lymph node staging in melanoma. J Clin Pathol 2003;56:283–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Fink AM, Holle-Robatsch S, Herzog N, Mirzaei S, Rappersberger K, Lilgenau N, et al. Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II. Melanoma Res 2004;14:141–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Schäfer A, Herbst RA, Beiteke U, Lange-Ionescu S, Treckmann H, Lohlein D, et al. [Sentinel lymph node excision (SLNE) and positron emission tomography in the staging of stage I–II melanoma patients]. Hautarzt 2003;54:440–7.PubMedGoogle Scholar
  18. 18.
    Wagner JD, Schauwecker D, Davidson D, Coleman JJ 3rd, Saxman S, Hutchins G, et al. Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol 1999;17:1508–15.PubMedGoogle Scholar
  19. 19.
    Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, et al. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 2000;41:1491–4.PubMedGoogle Scholar
  20. 20.
    Wagner JD, Schauwecker D, Davidson D, Logan T, Coleman JJ 3rd, Hutchins G, et al. Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer 2005;104:570–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003;44:1797–803.PubMedGoogle Scholar
  22. 22.
    Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 1970;172:902–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Berthelsen AK, Holm S, Loft A, Klausen TL, Andersen F, Hojgaard L. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients. Eur J Nucl Med Mol Imaging 2005;32:1167–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Burger C, Goerres G, Schoenes S, Buck A, Lonn AH, Von Schulthess GK. PET attenuation coefficients from CT images: experimental evaluation of the transformation of CT into PET 511-keV attenuation coefficients. Eur J Nucl Med Mol Imaging 2002;29:922–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Harpio R, Einarsson R. S100 proteins as cancer biomarkers with focus on S100B in malignant melanoma. Clin Biochem 2004;37:512–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Metz CE, Herman BA, Shen JH. Maximum likelihood estimation of receiver operating characteristic (ROC) curves from continuously-distributed data. Stat Med 1998;17:1033–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Bockisch A, Beyer T, Antoch G, Freudenberg LS, Kuhl H, Debatin JF, et al. Positron emission tomography/computed tomography—imaging protocols, artifacts, and pitfalls. Mol Imaging Biol 2004;6:188–99.PubMedCrossRefGoogle Scholar
  28. 28.
    Gritters LS, Francis IR, Zasadny KR, Wahl RL. Initial assessment of positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose in the imaging of malignant melanoma. J Nucl Med 1993;34:1420–7.PubMedGoogle Scholar
  29. 29.
    Krug B, Dietlein M, Groth W, Stutzer H, Psaras T, Gossmann A, et al. Fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in malignant melanoma. Diagnostic comparison with conventional imaging methods. Acta Radiol 2000;41:446–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Libberecht K, Husada G, Peeters T, Michiels P, Gys T, Molderez C. Initial staging of malignant melanoma by positron emission tomography and sentinel node biopsy. Acta Chir Belg 2005;105:621–5.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Felix M. Mottaghy
    • 1
    Email author
  • Cord Sunderkötter
    • 2
    • 3
  • Roland Schubert
    • 2
  • Petra Wohlfart
    • 1
  • Norbert M. Blumstein
    • 1
  • Bernd Neumaier
    • 1
  • Gerhard Glatting
    • 1
  • Cueneyt Özdemir
    • 2
  • Andreas K. Buck
    • 1
  • Karin Scharfetter-Kochanek
    • 2
  • Sven N. Reske
    • 1
  1. 1.Department of Nuclear MedicineUniversity Hospital UlmUlmGermany
  2. 2.Department of DermatologyUniversity Hospital UlmUlmGermany
  3. 3.Department of DermatologyUniversity Hospital MünsterMunsterGermany

Personalised recommendations