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A Prospective Analysis of Positron Emission Tomography and Conventional Imaging for Detection of Stage IV Metastatic Melanoma in Patients Undergoing Metastasectomy

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Abstract

Background: Positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose (FDG-PET) is available for evaluation of patients with melanoma. This study evaluates the potential of FDG-PET to improve on conventional imaging (CI) in patients with stage IV melanoma undergoing metastasectomy.

Methods: This was a prospective study comparing radiological evaluation of patients who underwent metastasectomy for palliation or cure. Patients underwent preoperative evaluation by physical examination, CI by computed tomography and/or magnetic resonance imaging, and FDG-PET. Independent observers performed three separate analyses of CI alone, FDG-PET alone, or FDG-PET read with knowledge of CI (FDG-PET + CI). Abnormalities were reported as benign or malignant and assessed by pathologic analysis or by clinical outcome determined by disease progression detected on serial evaluations.

Results: Ninety-four lesions were noted in 18 patients who underwent preoperative assessment, metastasectomy, and long-term follow up (median, 24 months). Lesion-by-lesion analysis for CI demonstrated a sensitivity of 76%, a specificity of 87%, a positive predictive value (PPV) of 86%, and a negative predictive value (NPV) of 76%. FDG-PET demonstrated a sensitivity of 79%, a specificity of 87%, a PPV of 86%, and an NPV of 80%. For FDG-PET + CI, the sensitivity was 88%, specificity was 91%, and PPV and NPV were 91% and 88%, respectively.

Conclusions: Combined use of FDG-PET and CI may be an accurate strategy to identify sites of disease in patients with stage IV melanoma being considered for metastasectomy. Interpreted independently, FDG-PET and CI seemed to be equivalent modalities. FDG-PET + CI had both the highest sensitivity on lesion-by-lesion analysis and the best accuracy on patient-by-patient analysis.

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REFERENCES

  1. Manola J, Atkins M, Ibrahim J, et al. Prognostic factors in metastatic melanoma: a pooled analysis of Eastern Cooperative Oncology Group trials. J Clin Oncol 2000; 18: 3782–93.

    PubMed  CAS  Google Scholar 

  2. Atkins MB, Lotze MT, Dutcher JP, et al. High-dose recombinant interleukin-2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol 1999; 17: 2105–16.

    CAS  PubMed  Google Scholar 

  3. Wood TF, DiFronzo LA, Rose DM, et al. Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival? Ann Surg Oncol 2001; 8: 658–62.

    PubMed  CAS  Google Scholar 

  4. Health Care Financing Administration. Decision memorandum posted concerning Medicare coverage of FDG positron emission tomography (No. CAG-00065), 12/00 update. Available at: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=85

  5. Conti PS, Lilien DL, Hawley K, Keppler J, Grafton ST, Bading JR. PET and [18F]-FDG in oncology: a clinical update. Nucl Med Biol 1996; 23: 717–35.

    PubMed  CAS  Google Scholar 

  6. 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.

    PubMed  CAS  Google Scholar 

  7. Steinert HC, Huch-Böni RA, Buck A, et al. Malignant melanoma: staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995; 195: 705–9.

    PubMed  CAS  Google Scholar 

  8. Böni R, Huch-Böni RA, Steinert H, et al. Staging of metastatic melanoma by whole-body positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose. Br J Dermatol 1995; 132: 556–62.

    Article  PubMed  Google Scholar 

  9. Blessing C, Feine U, Geiger L, Carl M, Rassner G, Fierlbeck G. Positron emission tomography and ultrasonography. A comparative study assessing the diagnostic validity in lymph node metastasis of malignant melanoma. Arch Dermatol 1995; 131: 1394–8.

    PubMed  CAS  Google Scholar 

  10. Damian DL, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 1996; 6: 325–9.

    Article  PubMed  CAS  Google Scholar 

  11. Wagner JD, Schauwecker D, Davidson D, et al. prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinal node biopsy. J Clin Oncol 1999; 17: 1508–15.

    PubMed  CAS  Google Scholar 

  12. 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: 1770–6.

    PubMed  CAS  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Holder WD Jr, White RL, Zuger JH, Easton EJ Jr, Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998; 227: 764–71.

    Article  PubMed  Google Scholar 

  15. Jadvar H, Johnson DL, Segall GM. The effect of fluorine-18-fluorodeoxyglucose positron emission tomography on the management of cutaneous malignant melanoma. Clin Nucl Med 2000; 25: 48–51.

    PubMed  CAS  Google Scholar 

  16. Acland KM, Healy C, Calonje E, et al. Comparison of positron emission tomography scanning and sentinal node biopsy in the detection of micrometastases of primary cutaneous melanoma. J Clin Oncol 2001; 19: 2674–8.

    PubMed  CAS  Google Scholar 

  17. Tyler DS, Onaitis M, Kherani A, et al. Positron emission tomography scanning in malignant melanoma: clinical utility in patients with stage III disease. Cancer 2000; 89: 1019–25.

    PubMed  CAS  Google Scholar 

  18. Eigtved A, Andersson AP, Dhalstrom K, 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.

    PubMed  CAS  Google Scholar 

  19. Krug B, Dietlein M, Groth W, 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.

    PubMed  CAS  Google Scholar 

  20. 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.

    PubMed  Google Scholar 

  21. Prichard RS, Hill AD, Skehan SJ, O’Higgins NJ. Positron emission tomography for staging and management of malignant melanoma. Br J Surg 2002; 89: 389–96.

    PubMed  CAS  Google Scholar 

  22. Mihnhout GS, Hoekstra OS, van Tulder MV, et al. Systematic review of the diagnostic accuracy of 18F fluorodeoxyglucose positron emission tomography in melanoma patients. Cancer 2001; 91: 1530–42.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

    Steven E. Finkelstein MD, Donald E. White MS, Steven A. Rosenberg MD, PhD & Richard M. Sherry MD

  2. Department of Nuclear Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland

    Jorge A. Carrasquillo MD & Barbara Galen RN

  3. Molecular Imaging Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

    John M. Hoffman MD

  4. Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland

    Peter Choyke MD

  5. Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 2338, 9000 Rockville Pike, Bethesda, MD, 20892

    Richard M. Sherry MD

Authors
  1. Steven E. Finkelstein MD
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  2. Jorge A. Carrasquillo MD
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  3. John M. Hoffman MD
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  4. Barbara Galen RN
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  5. Peter Choyke MD
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  6. Donald E. White MS
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  7. Steven A. Rosenberg MD, PhD
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  8. Richard M. Sherry MD
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Correspondence to Richard M. Sherry MD.

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Finkelstein, S.E., Carrasquillo, J.A., Hoffman, J.M. et al. A Prospective Analysis of Positron Emission Tomography and Conventional Imaging for Detection of Stage IV Metastatic Melanoma in Patients Undergoing Metastasectomy. Ann Surg Oncol 11, 731–738 (2004). https://doi.org/10.1245/ASO.2004.01.023

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  • DOI: https://doi.org/10.1245/ASO.2004.01.023

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