Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

Holder, Walter D.; White, Richard L.; Zuger, James H.; Easton, Edward J.; Greene, Frederick L.

doi:10.1097/00000658-199805000-00017

Cited by 236 publications

(191 citation statements)

References 22 publications

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“…CT scan was not routinely used in the early period of the series but accuracy remains very similar throughout (considering only the last 10 years, period 1985-1995: accuracy 86%). It is expected that spiral CT scan and possibly PET will improve the diagnostic power of radiological assessment (Holder et al, 1998). Applying the IRLM grouping system prospectively, it can be argued that limiting surgery for pulmonary metastases to Groups I and II would produce better results in melanoma patients.…”

Section: Discussionmentioning

confidence: 99%

Lung metastases from melanoma: when is surgical treatment warranted?

et al. 2000

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Prognosis of patients with metastatic melanoma is poor (Ketcham and Balch, 1985;Tafra et al, 1995), with an annual risk of death of about 20% during the first 3 years (Slingluff et al, 1992). The second most common site for metastatic spread is the lung (Balch and Milton, 1985), and the annual probability of developing pulmonary metastases increases progressively from 10% at 5 years to 17% at 15 years. Overall long-term survival for such patients is poor, with only 4% of patients alive at 4 years (Harpole et al, 1992).As effective chemotherapy for metastatic melanoma is not available, surgery can represent the only prospect of cure for highly selected patients (Wong et al, 1993;Karakousis et al, 1994). However only 10-12% of cases are suitable for surgery with curative intent (Cahan, 1973;Mountain et al, 1984;Thayer and Overholt, 1985;Pogrebniak et al, 1988;Gorenstein et al, 1991). Moreover, surgical results are still controversial as the majority of published studies are based on a small number of cases with relatively short follow-up.Two large series have already confirmed the prognostic value of factors such as radicality, number of resected metastases and disease-free interval (DFI) after pulmonary metastasectomy (Harpole et al, 1992;Tafra et al, 1995) but it remains unclear how these data can be used for preoperative patient selection.The purpose of this study is to evaluate the long-term results of surgery in melanoma pulmonary metastases from the International Registry of Lung Metastases (IRLM) data, with the aim of defining the subset of patients that really benefit from surgery. PATIENTS AND METHODSOf the 5206 patients recorded in the International Registry of Lung Metastases in the period 1945-1995, 328 (6.3%) had operations for pulmonary stage IV melanoma. The aims of the Registry, methodology of data collection and analysis have been published previously (Pastorino et al, 1997). In summary, all patients who had undergone resection of pulmonary metastases with curative intent were eligible for inclusion if their primary tumour, as well as metastases in other organs, had been effectively treated. Eighteen major centres from Europe, the USA and Canada took part in the project. Data analysisSurvival time was calculated from first metastasectomy to the last date of follow-up, by means of the Kaplan-Meier estimate. Mean follow-up of patients alive was 42 months.The impact on survival of the following variables was tested: age, sex, radicality of metastasectomy, time to pulmonary metastases (time from surgery of primary melanoma to diagnosis of pulmonary metastases, TPM), number of pathologically confirmed metastases, resection volume, nodal involvement, delay of surgery from diagnosis of metastases to metastasectomy, chemotherapy, Lung metastases from melanoma: when is surgical treatment warranted? Summary Surgical treatment of lung metastases from melanoma is highly controversial as the expected outcome is much poorer than for other primary tumours and a reliable system for selecting patients is lacking. ...

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Section: Discussionmentioning

confidence: 99%

Lung metastases from melanoma: when is surgical treatment warranted?

et al. 2000

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“…6-20 Some studies suggest that FDG-PET may be more sensitive and specific than conventional diagnostic tests for detecting this disease. 13,14,17,20 However, these studies have some important limitations, which include a lack of pathologic confirmation of suspected sites of metastatic disease and a relatively short clinical follow-up. In addition, most studies have determined specificity and sensitivity on the basis of a patient-by-patient analysis instead of a lesion-by-lesion analysis.…”

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confidence: 99%

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

et al. 2004

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“…Although the clinical context and the medical history of the patient can help in achieving an accurate diagnosis, the inherent pitfalls of metabolic imaging cannot be avoided in all circumstances. For instance, some benign tumours or infectious diseases may also take up 18 F-FDG, examples including leiomyoma, benign serous cystadenoma, benign fibroids, endometriosis and endometrioma [36,37,38]. Similarly, the inflammatory changes that follow the primary therapy (recent surgery or radiation therapy) can induce intense uptake of the metabolic tracer [39].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

Belhocine¹,

Barsy²,

Hustinx³

et al. 2002

Eur J Nucl Med

123

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Abstract. The aim of this study was to assess the usefulness of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the post-therapy surveillance of endometrial carcinomas. Forty-one fully corrected whole-body PET studies were performed in 34 women with previously treated endometrial cancers as a part of their follow-up programme. In 28 studies, FDG PET was indicated to localise a recurrence suspected at the control visits on the basis of clinical examination and/or radiological abnormalities (chest X-ray, CT or MRI) and/or elevated tumour marker levels (CA125, CEA). Another 13 studies were performed as a simple surveillance procedure. Overall, in 26 studies PET detected recurrent disease, which was confirmed either by histology (n=7) or by clinical and radiological outcomes (n=19). In 88% of the cases, the PET findings confirmed recurrence suggested by routine follow-up. In the remaining 12% of cases, PET detected asymptomatic recurrences that were unsuspected at the control visits. Whole-body PET accurately localised the site of confirmed recurrences as being above and below the diaphragm in 50%, only below the diaphragm in 35% and only above the diaphragm in 15%. In one patient, however, PET missed microscopic lung metastases shown on thoracic CT, and in three studies, metabolic imaging results were not confirmed. In 11 of 12 negative PET studies, no subsequent clinical or radiological recurrences were observed with a median follow-up of 10 months. Overall, the results of PET agreed well with the final diagnosis (Cohen's kappa coefficient =0.78). In 9/26 patients (35%) with confirmed recurrences, the PET findings significantly altered the treatment choice by detecting either clinically or radiologically unsuspected distant metastases. The sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of FDG PET imaging in the post-therapy surveillance of endometrial carcinomas were 96%, 78%, 90%, 89% and 91%, respectively. Indeed, the high likelihood ratio for a positive test result (4.5) and the low likelihood ratio for a negative test result (0.05) demonstrated the clinical utility of metabolic imaging in "ruling in" disease as well as "ruling out" recurrence. In conclusion, whole-body FDG PET appears useful in the post-therapy surveillance of endometrial cancers, both for the accurate localisation of suspected recurrences and for the detection of asymptomatic recurrent disease.

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Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

Cited by 236 publications

References 22 publications

Lung metastases from melanoma: when is surgical treatment warranted?

Lung metastases from melanoma: when is surgical treatment warranted?

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

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

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