Futility of Fluorodeoxyglucose F 18 Positron Emission Tomography in Initial Evaluation of Patients With T2 to T4 Melanoma

Clark, Paige B.; Soo, Victoria; Kraas, Jonathan R.; Shen, Perry; Levine, Edward A.

doi:10.1001/archsurg.141.3.284

Cited by 89 publications

(60 citation statements)

References 8 publications

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“…In the course of initial staging up to stage IIB, the sensitivity of PET and PET/CT for the detection of clinically occult locoregional lymph node metastases is low and clearly inferior to sentinel lymph node scintigraphy with subsequent lymph node dissection [104,105,130,132,[134][135][136][137][138][139]. PET or PET/CT with fluorodeoxyglucose (FDG) should not be performed for the detection and/or localization of locoregional lymph node metastasis.…”

Section: S Reskementioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

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Section: S Reskementioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

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“…1 Although early detection of occult metastases may impact prognosis and alter treatment strategies, previously published reports fail to demonstrate that the use of extensive preoperative radiologic imaging at the time of initial melanoma diagnosis in otherwise asymptomatic patients leads to a significant detection of occult metastases, or has an impact on survival. [2][3][4][5][6] Furthermore, there is a lack of universally accepted guidelines detailing the initial staging process. Staging and follow-up recommendations differ from country to country, with significant variation in expert opinion and practice.…”

Section: P Atients Diagnosed With Intermediate Risk Cutaneous Melanomamentioning

confidence: 99%

Role of radiologic imaging at the time of initial diagnosis of stage T1b‐T3b melanoma

Yancovitz

Finelt

Warycha

et al. 2007

Cancer

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BACKGROUND. In patients with T1b‐T3b cutaneous melanoma the utility of radiologic imaging at the time of diagnosis is unclear. Whether initial imaging led to a change in stage or treatment plan was investigated. METHODS. The melanoma database was searched for patients with T1b‐T3b primary lesions, clinically N0, and asymptomatic for metastatic disease. Radiologic studies conducted before wide local excision ± sentinel lymph node biopsy as well as all further imaging and investigations were analyzed. Outcome measures included upstaging, change in initial surgical management, true‐positive, false‐positive, true‐negative, and false‐negative rates of each imaging modality. RESULTS. In all, 344 preoperative imaging studies (chest x‐ray [CXR], computed tomography [CT], positron emission tomography [PET]/CT) were performed on 158 patients, resulting in 49 findings suspicious for metastatic melanoma and 134 findings suggestive of nonmelanoma pathology. Only 1 of 344 (0.3%) studies, a PET/CT, correlated with confirmed metastatic melanoma. The false‐positive rates were CXR 5 of 7 (71.4%), chest CT 21 of 24 (87.5%), abdomen/pelvis CT 10 of 11 (90.9%), head CT 2 of 2 (100.0%), PET/CT 3 of 5 (60.0%). No patient was upstaged or had a change in initial surgical management based on preoperative imaging. The cost of all initial imaging and imaging to follow‐up abnormal findings was estimated as $555,308 for the 158 patients studied. CONCLUSIONS. Imaging at the time of initial diagnosis of T1b‐T3b, clinically N0, M0 melanoma was of low yield with a high false‐positive rate, and did not lead to upstaging or change in initial surgical management. These findings suggest that imaging of asymptomatic patients at the time of diagnosis may not be warranted. Cancer 2007. © 2007 American Cancer Society.

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“…PET is a more useful in detecting subclinical metastases. It is widely accepted that, for patients with early localized melanoma, PET is not sensitive in detecting the metastatic lesions and thus can not satisfactorily benefit the patients (40)(41)(42). PET/ CT is more useful in stage III patients because it can help to identify lesions that can not be diagnosed by CT and display locations that can not be displayed by conventional CT (e.g., limbs) (43).…”

Section: Medical Imagingmentioning

confidence: 99%