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3'-¹⁸F-Fluoro-3'-Deoxy-L-Thymidine: A New Tracer for Staging Metastatic Melanoma?

¹ PET Center, Groningen University Hospital, Groningen, The Netherlands
² Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands
³ Department of Pathology and Laboratory Medicine, Groningen University Hospital, Groningen, The Netherlands

In this study, the feasibility of 3'-¹⁸F-fluoro-3'-deoxy-L-thymidine PET (¹⁸F-FLT PET) for staging patients with clinical stage III melanoma was investigated. Methods: Ten patients with melanoma and metastases to the locoregional draining lymph nodes, clinical stage III—based on physical examination, chest radiography, lactate dehydrogenase, and histopathologic confirmation—underwent a whole-body ¹⁸F-FLT PET scan 1 h after injection of a median 400-MBq dose (range, 185–430 MBq) of ¹⁸F-FLT. All ¹⁸F-FLT PET lesions were verified using the American Joint Committee on Cancer Staging System, which includes physical examination, spiral CT, ultrasound, chest radiography, and histopathologic examinations. Size and mitotic rate of metastatic lymph nodes and skin metastases were determined. Results: All histopathologic samples and ¹⁸F-FLT PET lesions were categorized over anatomic regions and correlated. All locoregional metastases were correctly visualized by ¹⁸F-FLT PET. Region-based sensitivity for detection of lymph node metastatic disease was 88%. There were 3 true-negative and 2 false-positive lesions. The detection limit for lymph node metastases appeared to be approximately 6 mm or a mitotic rate of 9 mitoses per 2 mm². Two patients were upstaged by ¹⁸F-FLT PET, which was confirmed by CT. In 3 patients, ¹⁸F-FLT PET detected a total of 3 additional lesions with therapeutic consequences, without influencing staging. These lesions were initially missed by clinical staging. Conclusion: ¹⁸F-FLT PET seems promising for (re)staging purposes in clinical stage III melanoma. Further research is needed, in which ¹⁸F-FLT PET should be compared with ¹⁸F-FDG PET.

Key Words: 3'-¹⁸F-fluoro-3'-deoxy-L-thymidine • melanoma • staging • PET

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