Abstract
Purpose
Positron emission tomography (PET) scanning is an efficient and well-known diagnostic tool in various malignant disorders. However, the utility of PET as a clinical routine screening procedure for the detection of subclinical metastases in stage III melanoma patients has not yet been established.
Methods
Thirty-three patients with cutaneous malignant melanoma and subclinical lymph node metastases diagnosed by sentinel node biopsy (SNB) were submitted to 18F-fluoro-2-deoxy-D-glucose (FDG) whole-body PET scanning within 100 days after SNB and wide local excision. Before PET scanning, patients were screened conventionally and found to be without evidence of further dissemination. Positive PET scan findings were evaluated by computed tomography scanning, magnetic resonance imaging and ultrasonography. Biopsy was performed whenever possible. The median follow-up was 15 months (range 6–39 months).
Results
Nine patients (27%) had a positive PET scan performed after SNB and WLE. On verification, four cases (12%) were found to be true positive for melanoma metastasis and were thus upgraded from stage III to stage IV. Furthermore, one patient (3%) had another primary malignancy (prostate carcinoma), and two (6%) were found to have non-malignant lesions. Two PET-positive patients (6%) refused further investigations. In one case (3%) the PET scan was false negative. Twenty-three (69%) PET scans were true negative.
Conclusion
In a number of stage III melanoma patients with positive SNB, postoperative whole-body FDG-PET scanning revealed further melanoma dissemination not found by conventional screening methods and thus identified these cases as stage IV. Relevant therapy can accordingly be instituted earlier on the basis of FDG-PET scanning.
Similar content being viewed by others
References
Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002—Cancer incidence, mortality and prevalence worldwide. IARC CancerBase no. 5, version 2.0. Lyon: IARC Press; 2004
Balch CM, Soong S, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:3622–3634
Balch CM, Buzaid AC, Soong S, Atkins MB, Cascinelli N, Coit DG. Final version of the American Joint Committee on cancer staging system for cutaneous melanoma. J Clin Oncol 2001;19:3635–3648
Dalrymple-Hay MJ, Rome PD, Kennedy C, Fulham M, McCaughan BC. Pulmonary metastatic melanoma—the survival benefit associated with positron emission tomography scanning. Eur J Cardiothorac Surg 2002;21:611–614
Wong SL, Coit DG. Role of surgery in patients with stage IV melanoma. Curr Opin Ocol 2004;16:155–160
Sharpless SM, Das Gupta TK. Surgery for metastatic melanoma. Semin Surg Oncol 1998;14:311–318
Czernin J, Phelps ME. Positron emission tomography scanning. Current and future applications. Ann Rev Med 2002;53:89–112
Rohren EM, Turkington TG, Colemn RE. Clinical applications of PET in oncology. Radiology 2004;231:305–332
Wagner JD, Schauwecker DS, Davidson D, Wenck S, Jung SH, Hutchins G. FDG-PET sensitivity for melanoma lymph node metastases is dependent on tumor volume. J Surg Oncol 2001;77:237–242
Eigtved A, Andersson A, Dahlstrom K, Rabøl A, Jensen M, Holm S, et al. Use of fluorine-18 fluoroddeoxyglucose positron emission tomography in the detection of silent metastases from malignant melanoma. Eur J Nucl Med 2000;27:70–75
Damian DL, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 1996;6:325–329
Swetter S, Carroll L, Johnson D, Segall G. Positron emission tomography (PET) is superior to computerized tomography (CT) for metastatic staging in melanoma patients. Clin Positron Imaging 2000;3:154
Wagner JD, Schauwecker D, Davidson D, Colemann JJ 3rd, Saxman S, Hutchins G, et al. Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol 1999;17:1508–1515
Longo MI, Lazaro P, Bueno C, Carreras Jl, Montz R. Fluorodeoxyglucose-positron emission tomography imaging versus sentinel node biopsy in the primary staging of melanoma patients. Dermatol Surg 2003;29:245–248
Lock-Andersen J, Horn J, Sjøstrand H, Nurnberg BM, Stokholm KH. Sentinel node biopsy in cutaneous melanoma. Scand J Plast Reconstr Surg Hand Surg 2006;40:24–31
Fincher TR, McCarty TM, Fisher TL, Preskitt JT, Lieberman ZH, Stephens JF. Patterns of recurrence after sentinel node biopsy for cutaneous melanoma. Am J Surg 2003;186:675–681
Wagner JD, Ranieri J, Evdokimow DZ, Logan T, Chuang TY, Johnson CS, et al. Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg 2003;112:486–497
Prichard RS, Hill AD, Skehan SJ, O’Higgins NJ. Positron emission tomography for staging and management of malignant melanoma. Br J Surg 2002;89:389–396
Holder WD Jr, White RL Jr, Zuger JH, Easton EJ Jr, Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998;225:764–771
Rinne D, Baum RP, Hor G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography. Cancer 1998;82:1664–1671
Gulec SA, Faries MB, Lee CC, Kirgan D, Glass C, Morton DL, et al. The role of fluorine-18 deoxyglucose positron emission tomography in the management of patients with metastatic melanoma: impact on surgical decision making. Clin Nucl Med 2003:28:961–965
Hossein J, 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
Nguyen AT, Akhurst T, Larson SM, Coit DG, Brady MS. PET scanning with 18F-2-fluoro-2-deoxy-D-glucose(FDG) in patients with melanoma: benefits and limitations. Clin Positron Imaging 1999;2:93–98
Fuster D, Chiang S, Johnson G, Schuchter LM, Zhuang H, Alavi A. Is 18F-FDG more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma? J Nucl Med 2004;45:1323–1327
Schauwecker DS, Siddiqui AR, Wagner JD, Davidson D, Jung SH, Carlson KA, et al. Melanoma patients evaluated by four different positron emission tomography reconstruction techniques. Nucl Med Common 2003;24(3):281–289
Author information
Authors and Affiliations
Corresponding author
Additional information
Statement: We have no financial sponsorship. This study has been executed in a public hospital, and we have full control of all primary data. We agree to allow the EJNMMI to review our data if requested.
Rights and permissions
About this article
Cite this article
Horn, J., Lock-Andersen, J., Sjøstrand, H. et al. Routine use of FDG-PET scans in melanoma patients with positive sentinel node biopsy. Eur J Nucl Med Mol Imaging 33, 887–892 (2006). https://doi.org/10.1007/s00259-006-0077-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-006-0077-7