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Clinical Value of Radiographic Staging in Patients Diagnosed With AJCC Stage III Melanoma

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with American Joint Committee on Cancer (AJCC) stage III melanoma represent patients with high risk of systemic relapse. This study evaluates the clinical utility of standardized radiographic staging.

Methods

Consecutive asymptomatic patients underwent standardized radiographic staging workup within 6 weeks of diagnosis. True- and false-positive rates and number of additional examinations generated after a positive initial report were quantified. All suspicious findings were further studied by biopsy and/or by clinical or radiologic assessment.

Results

Fifty-eight patients underwent complete radiographic staging. Nineteen (33%) had ulcerated primary tumors. Forty-two patients (73%) presented with clinically negative lymph nodes that were positive on sentinel lymph node biopsy. Lymph node involvement was classified as N1a in 54%, N2a in 19%, N2b in 3%, and N3 in 22% of patients. Among 204 staging examinations in 58 patients, 52 (25%) were initially reported as positive. Three percent of all examinations proved truly positive; 23% were falsely positive. Analyzed per patient, in 37 (64%) of 58 patients, at least one examination was initially reported as positive. However, only 3 patients (5%) had a true-positive and 34 (59%) had at least one false-positive report. The positive reports of the staging scans generated 45 additional examinations (0.78 per patient).

Conclusions

Radiographic staging in asymptomatic patients with stage III melanoma detects a low number of patients with unsuspected systemic disease. The ratio of falsely to truly positive is approximately 11:1. Radiographic screening should only be considered in patients with high-risk prognostic features or symptoms, or in the context of clinical trials.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Prakash K. Pandalai MD, Francisco J. Dominguez MD, James Michaelson PhD & Kenneth K. Tanabe MD

  2. Massachusetts General Hospital, Boston, MA, USA

    Kenneth K. Tanabe MD

Authors
  1. Prakash K. Pandalai MD
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  2. Francisco J. Dominguez MD
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  3. James Michaelson PhD
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  4. Kenneth K. Tanabe MD
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Corresponding author

Correspondence to Kenneth K. Tanabe MD.

Additional information

Poster presentation at the Annual Meeting of the Society of Surgical Oncology in March, 2010.

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Pandalai, P.K., Dominguez, F.J., Michaelson, J. et al. Clinical Value of Radiographic Staging in Patients Diagnosed With AJCC Stage III Melanoma. Ann Surg Oncol 18, 506–513 (2011). https://doi.org/10.1245/s10434-010-1272-0

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  • DOI: https://doi.org/10.1245/s10434-010-1272-0

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