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Performance of Long-Term CT and PET/CT Surveillance for Detection of Distant Recurrence in Patients with Resected Stage IIIA–D Melanoma

  • Melanoma
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Abstract

Background

Follow-up for patients with resected stage IIIA–D melanoma may include computed tomography (CT) or positron emission tomography (PET)/CT imaging to identify distant metastases. The aim of this study was to evaluate the test performance over follow-up time, of structured 6- and 12-monthly follow-up imaging schedules in these patients.

Methods

We conducted a retrospective analysis of consecutive resected stage IIIA–D melanoma patients from Melanoma Institute Australia (2000–2017). Patients were followed until a confirmed diagnosis of distant metastasis, end of follow-up schedule, or death. Test accuracy was evaluated by cross-classifying the results of the test against a composite reference standard of histopathology, cytology, radiologic imaging, and/or clinical follow-up, and then quantified longitudinally using logistic regression models with random effects.

Results

In total, 1373 imaging tests were performed among 332 patients. Distant metastases were detected in 110 (33%) patients during a median follow-up of 61 months (interquartile range 38–86), and first detected by imaging in 86 (78%) patients. 152 (68%) patients had at least one false-positive result. Sensitivity of the schedule over 5 years was 79% [95% confidence interval (CI) 70–86%] and specificity was 88% (95% CI 86–90%). There was no evidence of a significant difference in test performance over follow-up time or by American Joint Committee on Cancer (AJCC) substage. The positive predictive value ranged between 33 and 48% over follow-up time, reflecting a ratio of 1:2 false-positives per true-positive finding.

Conclusions

Regular 6- or 12-monthly surveillance imaging using CT or PET/CT has reasonable and consistent sensitivity and specificity over 5-year follow-up for resected stage IIIA–D melanoma patients. These data are useful when discussing the risks and benefits of long-term follow-up.

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Acknowledgements

We thank our patients, whose data were used in this study, and their families. Thanks also to Hazel Burke of MIA for helping to extract patient data from the Melanoma Research Database.

Funding

Cancer Australia, Priority-driven Collaborative Cancer Research Scheme Grant #1129568; Australian National Health and Medical Research Council (NHMRC) Melanoma Centre of Research Excellence Grant #1135285; NHMRC Fellowship #1150989 and University of Sydney, Robinson Fellowship to RLM.

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Author notes

  1. Robin M. Turner and Mbathio Dieng contributed equally to this work.

Authors and Affiliations

  1. Centre for Biostatistics, University of Otago, Dunedin, New Zealand

    Robin M. Turner PhD, MBiostat

  2. NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

    Mbathio Dieng PhD, MPH, Nikita Khanna MEcon, Mai Nguyen MSc, Sarah J. Lord MBBS, MSc & Rachael L. Morton PhD, MSc

  3. Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

    Jiaxu Zeng PhD

  4. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

    Amanda A. G. Nijhuis MD, PhD, Omgo E. Nieweg PhD, MD, Alexander M. Menzies PhD, MD, John F. Thompson MD, Robyn P. M. Saw MD & Rachael L. Morton PhD, MSc

  5. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    Omgo E. Nieweg PhD, MD, Alexander M. Menzies PhD, MD, John F. Thompson MD, Robyn P. M. Saw MD & Rachael L. Morton PhD, MSc

  6. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Omgo E. Nieweg PhD, MD, John F. Thompson MD & Robyn P. M. Saw MD

  7. Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA

    Andrew J. Einstein MD, PhD

  8. Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia

    Louise Emmett MD

  9. Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia

    Alexander M. Menzies PhD, MD

Authors
  1. Robin M. Turner PhD, MBiostat
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  2. Mbathio Dieng PhD, MPH
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  3. Nikita Khanna MEcon
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  11. Alexander M. Menzies PhD, MD
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  14. Rachael L. Morton PhD, MSc
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Corresponding author

Correspondence to Mbathio Dieng PhD, MPH.

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Disclosures

John F. Thompson has received honoraria for advisory board participation from BMS Australia, MSD Australia, GSK and Provectus Inc., and travel support from GSK and Provectus Inc. Robyn P.M. Saw has received honoraria for advisory board participation from MSD Australia and Novartis, and speaking honoraria from BMS Australia. Alexander M. Menzies has received honoraia for advisory board participation from BMS, MSD, Novartis, Roche, and Pierre-Fabre, and QBiotics. Robin M. Turner, Mbathio Dieng, Nikita Khanna, Mai Nguyen, Jiaxu Zeng, Amanda A.G. Nijhuis, Omgo E. Nieweg, Andrew J. Einstein, Louise Emmett, Sarah J. Lord, and Rachael L. Morton have no disclosures to declare.

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Treatment of scan-detected recurrences (JPEG 68 kb)

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Turner, R.M., Dieng, M., Khanna, N. et al. Performance of Long-Term CT and PET/CT Surveillance for Detection of Distant Recurrence in Patients with Resected Stage IIIA–D Melanoma. Ann Surg Oncol 28, 4561–4569 (2021). https://doi.org/10.1245/s10434-020-09270-3

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