Abstract
Background
Whole-body positron emission tomography (PET) provides diagnostic information not currently available with traditional imaging and may improve the accuracy of staging melanoma patients.
Methods
A retrospective cohort review was performed of 104 patients with primary or recurrent melanoma who underwent PET to determine sensitivity/specificity for metastatic detection compared with body computed tomography (CT). One hundred fifty-seven PET and 70 CT scans were analyzed, with a median patient follow-up of 24 months. Metastases were confirmed with positive histology (87.5%) or documented disease progression (12.5%). Fifty-three patients prospectively underwent consecutive studies within a mean 3-week interval for direct comparative analysis.
Results
PET demonstrated 84% sensitivity (95% confidence interval [CI], .78 to .89) and 97% specificity (95% CI, .91 to .99), whereas CT showed 58% sensitivity (95% CI, .49 to .66) and 70% specificity (95% CI, .51 to .84). Exclusion of areas not evaluated on CT (head, neck/supraclavicular, extremities) increased CT sensitivity to 69% (95% CI, .59 to .77). Sixty-six consecutive PET and CT scans were performed with 81% and 57% of metastases detected, respectively.
Conclusions
PET is more sensitive and specific than CT for detection of melanoma metastasis and should be considered the primary staging study for recurrent disease. PET shows greater ability to detect soft tissue, small-bowel, and lymph node metastasis that do not meet criteria designated as abnormal by CT. PET is superior to CT even when sites not routinely evaluated by CT are excluded from comparative analysis.
Similar content being viewed by others
References
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.
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.
Böni R, Huch-Böni RA, Steinert H, von Schulthess GK, Burg G. 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.
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.
Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients.Cancer 1998;82:1664–71.
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.
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.
Acland KM, O’Doherty MJ, Russell-Jones R. The value of positron emission tomography scanning in the detection of subclinical metastatic melanoma.J Am Acad Dermatol 2000;42:606–11.
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.
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.
Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.
McMasters KM, Sondak VK, Sotze MT, Ross MI. Recent advances in melanoma staging and therapy.Ann Surg Oncol 1999; 6:467–75.
Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.J Clin Oncol 1999;17:976–83.
Larson SM, Weiden PL, Grunbaum Z, et al. Positron imaging feasibility studies II: characteristics of 2-deoxyglucose uptake in rodent and canine neoplasms.J Nucl Med 1981;22:875–9.
Hoh CK, Hawkins RA, Glaspy JH, et al. Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-d-glucose.J. Comput Assist Tomogr 1993;17:582–9.
Balch CM, Buzaid AC, Soong S-J, Atkins MB, Casciinelli N, Coit DG. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma.J Clin Oncol 2001;19: 3635–48.
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.
Wong CS, Valk P, Ariannejad M, et al. Impact of FDG-PET on management of patients with melanoma (abstract).J Nucl Med 2000;41(Suppl):282.
Wagner JD, Schauwecker D, Hutchins G, Coleman JJ III. Initial assessment of positron emission tomography for detection of nonpalpable regional lymphatic metastases in melanoma.J Surg Oncol 1997;64:181–9.
Wagner JD, Schauwecker D, Davidson D, et al. Prospective study of fluorodeoxyglucose-positron emission tomograpy imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy.J Clin Oncol 1999;17:1508–15.
Acland KM, Healy C, Calonje E, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastasis of primary cutaneous malignant melanoma.J Clin Oncol 2001;19:2674–8.
Lewis P, Griffin S, Marsden P, et al. Whole-body18F-fluorode-oxyglucose positron emission tomography in preoperative evaluation of lung cancer.Lancet 1994;344:1265–6.
Hoh CK, Glaspy J, Rosen P, et al. Whole-body FDG-PET imaging for staging of Hodgkin’s disease and lymphoma.J Nucl Med 1997;38:343–7.
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/coverage/8b3-hh2.asp. Accessed July 25, 2001.
Charron M, Beyer T, Bohnen NN, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner.Clin Nucl Med 2000;25:905–10.
Israel O, Keidar Z, Iosilevsky G, Bettman L, Sachs J, Frenkel A. The fusion of anatomic and physiologic imaging in the management of patients with cancer.Semin Nucl Med 2001;31:191–205.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Swetter, S.M., Carroll, L.A., Johnson, D.L. et al. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Annals of Surgical Oncology 9, 646–653 (2002). https://doi.org/10.1007/BF02574480
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02574480