Sentinel Lymph Node Excision and PET-CT in the Initial Stage of Malignant Melanoma

Abstract

SLNE is much more sensitive than PET-CT in discovering small lymph node metastases. We consider PET-CT unsuitable for the evaluation of early regional lymphatic tumor dissemination in this patient population and recommend that it be limited to malignant melanomas of American Joint Committee on Cancer stages III and IV. We therefore recommend the routine use of SLNE for tumor staging and stratification for adjuvant therapy of patients with stage I and II malignant melanoma.

Comparison between18F-Fluorodeoxyglucose Positron Emission Tomography and Sentinel Lymph Node Biopsy for Regional Lymph Nodal Staging in Patients with Melanoma: A Review of the Literature

“…Recently, Klode et al [21] sought to clarify the role of SLNB in the evaluation of the initial stages of 61 patients with primary melanoma (AJCC stages I and II; Breslow thickness >1 mm) by comparing it directly with FDG-PET/CT evaluation. Metastatic SLNs were found in 14 patients (23%); 17 metastatic lymph nodes were detected overall, only one of which was identified preoperatively using FDG-PET/CT.…”

“…The results of this study showed that initial-stage FDG-PET/CT in patients with AJCC stage I or II melanoma does not offer any advantage over SLNB with respect to the detection of local and regional metastases, because lymph nodal micrometastases cannot reliably be detected. SLNB, on the other hand, is a more sensitive procedure to diagnose lymph nodal metastases of melanoma and continues to be the criterion standard for the classification and stratification for adjuvant therapy of patients with AJCC stage I or II melanoma [21]. …”

“…Indeed in patients with early-stage disease (AJCC stage I or II, without regional lymph nodal or distant metastases), the sensitivity of FDG-PET/CT is unacceptably low, with most reported values ranging from 0% to 22% [4, 7, 9, 11, 12, 15, 16, 18, 20, 21]. Slightly higher- and yet too low-sensitivity values (40%) were found only for intermediate/high-risk melanoma patients [14], in whom metastatic adenopathy is more likely.…”

Preclinical Lymphatic Imaging

“…Indeed, in breast cancer patients, the sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58, 92, 82, 77 and 79%, indicating that FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB [117]. Low sensitivity of PET/CT also has been reported in patients with primary malignant melanoma [118]. …”

Comparison between 18F-FDG PET (PET/CT) and sentinel lymph node biopsy in the detection of regional lymph node metastasis of various malignancies: review of the literature

“…A study by Klode et al [43] directly compared SLNE and 18 F-FDG PET/CT in the evaluation of early-stage melanoma metastasis by analyzing data from 61 patients with primary malignant melanoma with a Breslow index > 1.0 mm. SLN involvement was found in 14 patients (23%).…”