Advertisement

Diagnostic accuracy of contrast-enhanced FDG-PET/CT in primary staging of cutaneous malignant melanoma

  • Patrick Veit-HaibachEmail author
  • Florian M. Vogt
  • Robert Jablonka
  • Hilmar Kuehl
  • Andreas Bockisch
  • Thomas Beyer
  • Gerlinde Dahmen
  • Sandra Rosenbaum
  • Gerald Antoch
Original Article

Abstract

Purpose

To evaluate the diagnostic accuracy of contrast-enhanced FDG-PET/CT (ce-PET/CT), PET-only, and CT-only in patients with newly diagnosed and resected cutaneous malignant melanoma.

Methods

A final group of 56 patients (mean age 62 years, range 23–86 years; 29 women, 27 men) were staged with ce-PET/CT after resection of the primary tumour. Histopathology as well as clinical follow-up (mean 780 days, range 102–1,390 days) served as the standards of reference. Differences between the staging modalities were tested for statistical significance with McNemar’s test.

Results

All imaging procedures provided low sensitivities in the detection of lymph nodes (sensitivity N-stage: PET/CT and PET-only 38.5%; CT-only 23.1%) and distant metastases (sensitivity M-stage: PET/CT 41.7%, PET-only 33.3%, CT-only 25.0%) in initial staging after resection of the primary tumour. No statistically significant differences were detected between the imaging procedures (p > 0.05). PET/CT resulted in an alteration in further treatment in two patients compared to PET-only and in four patients compared to CT-only.

Conclusion

All imaging modalities had a low sensitivity on initial staging of patients with malignant melanoma. Thus, close patient follow-up must be considered mandatory.

Keywords

ce-PET/CT Cutaneous melanoma Staging Follow-up Diagnostic accuracy 

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57 1:43–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19 16:3622–34.PubMedGoogle Scholar
  3. 3.
    Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Annals of surgery Nov 1970;172 5:902–8.Google Scholar
  4. 4.
    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 16:3635–48.PubMedGoogle Scholar
  5. 5.
    Day CL Jr, Sober AJ, Lew RA, Mihm MC Jr, Fitzpatrick TB, Kopf AW, et al. Malignant melanoma patients with positive nodes and relatively good prognoses: microstaging retains prognostic significance in clinical stage I melanoma patients with metastases to regional nodes. Cancer 1981;47 5:955–62.PubMedCrossRefGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network. Fort Washington, PA. http://www.nccn.org.
  7. 7.
    Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med 2004;351 10:998–1012.PubMedCrossRefGoogle Scholar
  8. 8.
    Friedman KP, Wahl RL. Clinical use of positron emission tomography in the management of cutaneous melanoma. Semin Nucl Med 2004;34 4:242–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Gambhir SS, Czernin J, Schwimmer J, Silverman DH, Coleman RE, Phelps ME. A tabulated summary of the FDG PET literature. J Nucl Med 2001;42 5 Suppl:1S–93S.PubMedGoogle Scholar
  10. 10.
    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 7:1178–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Strobel K, Dummer R, Husarik DB, Perez Lago M, Hany TF, Steinert HC. High-risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology 2007;244 2:566–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Strobel K, Skalsky J, Steinert HC, Dummer R, Hany TF, Bhure U, et al. S-100B and FDG-PET/CT in therapy response assessment of melanoma patients. Dermatology 2007;215 3:192–201.PubMedCrossRefGoogle Scholar
  13. 13.
    Antoch G, Freudenberg LS, Stattaus J, Jentzen W, Mueller SP, Debatin JF, et al. Whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. AJR Am J Roentgenol 2002;179 6:1555–60.PubMedGoogle Scholar
  14. 14.
    Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging 2003;30 4:588–96.PubMedGoogle Scholar
  15. 15.
    Delbeke D, Martin WH, Sandler MP, Chapman WC, Wright JK Jr, Pinson CW. Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg 1998;133 5:510–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Valk PE, Bailey DL, Townsend DW, Maisey MN. Positron emission tomography: basic science and clinical practice. Berlin: Springer; 2003.Google Scholar
  17. 17.
    American Joint Committee on Cancer. Cancer staging manual. 6th edition. Heidelberg: Springer; 2002.Google Scholar
  18. 18.
    European Society for Medical Oncology. Viganello-Lugano, Switzerland. http://www.esmo.org.
  19. 19.
    Tango T. Equivalence test and confidence interval for the difference in proportions for the paired-sample design. Stat Med 1998;17 8:891–908.PubMedCrossRefGoogle Scholar
  20. 20.
    Fuster D, Chiang S, Johnson G, Schuchter LM, Zhuang H, Alavi A. Is 18F-FDG PET more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma? J Nucl Med 2004;45 8:1323–7.PubMedGoogle Scholar
  21. 21.
    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 9:1491–4.PubMedGoogle Scholar
  22. 22.
    Rinne D, Baum RP, Hor 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 9:1664–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Wagner JD, Schauwecker DS, Davidson D, Wenck S, Jung SH, Hutchins G. FDG-PET sensitivity for melanoma lymph node metastases is dependent on tumor volume. J Surg Oncol 2001;77 4:237–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Tyler DS, Onaitis M, Kherani A, Hata A, Nicholson E, Keogan M, et al. Positron emission tomography scanning in malignant melanoma. Cancer 2000;89 5:1019–25.PubMedCrossRefGoogle Scholar
  25. 25.
    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 3:570–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Schoder H, Larson SM, Yeung HW. PET/CT in oncology: integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med 2004;45 Suppl 1:72S–81S.PubMedGoogle Scholar
  27. 27.
    Belhocine T, Pierard G, De Labrassinne M, Lahaye T, Rigo P. Staging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection. Oncologist 2002;7 4:271–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Havenga K, Cobben DC, Oyen WJ, Nienhuijs S, Hoekstra HJ, Ruers TJ, et al. Fluorodeoxyglucose-positron emission tomography and sentinel lymph node biopsy in staging primary cutaneous melanoma. Eur J Surg Oncol 2003;29 8:662–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Macfarlane DJ, Sondak V, Johnson T, Wahl RL. Prospective evaluation of 2-[18F]-2-deoxy-D-glucose positron emission tomography in staging of regional lymph nodes in patients with cutaneous malignant melanoma. J Clin Oncol 1998;16 5:1770–6.PubMedGoogle Scholar
  30. 30.
    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 5:1508–15.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Patrick Veit-Haibach
    • 1
    • 5
    Email author
  • Florian M. Vogt
    • 1
  • Robert Jablonka
    • 2
  • Hilmar Kuehl
    • 1
  • Andreas Bockisch
    • 3
  • Thomas Beyer
    • 3
  • Gerlinde Dahmen
    • 4
  • Sandra Rosenbaum
    • 3
  • Gerald Antoch
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
  2. 2.Department of DermatologyUniversity Hospital EssenEssenGermany
  3. 3.Department of Nuclear MedicineUniversity Hospital EssenEssenGermany
  4. 4.Institute of Medical Biometry and StatisticsUniversity at LuebeckLuebeckGermany
  5. 5.Department of Medical Radiology, Division of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations