The diagnostic accuracy and clinical impact of FDG-PET/CT follow-up for patients on adjuvant immunotherapy for high-risk malignant melanoma

Abstract

Objective The benefit of FDG-PET/CT in follow-up of patients treated with adjuvant immunotherapy after resection of highrisk malignant melanoma (MM) is debated. This study evaluated the diagnostic accuracy and clinical impact of FDG-PET/ CT for diagnosing MM recurrence during the first year after surgery. Methods We retrospectively included 124 patients with resected high-risk MM, who received adjuvant immunotherapy and follow-up FDG-PET/CT. Clinical information and AJCC-8 stage was obtained from patients' medical records. Recurrence was verified by biopsy/progression on a subsequent scan leading to change of treatment. Non-recurrence was assumed when no metastases were observed until the subsequent follow-up scan. Incidence of recurrence, sensitivity, specificity, positive and negative predictive values (PPV and NPV) were outcome measures. Results Incidence rate of MM recurrence was 0.27 [95% CI 0.17-0.37] per person-year during the first-year. Recurrence was detected in 13 patients (10%) at 3-month FDG-PET/CT, in 10 patients (8.1%) at 6 months, 1 patient (0.8%) at 9 months, 3 patients (2.4%) at 12 months. The overall sensitivity, specificity, PPV, and NPV were 97% [86-99], 82% [78][79][80][81][82][83][84][85][86], 39% , and 99% [98-99], respectively. The PPV trended towards higher values as disease stage increased. At the 3-month scan, the majority of actions derived from positive findings were surgery or earlier expedition of the subsequent follow-up scan. ConclusionThe high rate of recurrence in patients with high-risk MM treated with adjuvant immunotherapy emphasizes the need for follow-up. The potential harm by a moderately low specificity reflecting a high number of false-positive results must be weighed against the benefit of early detection of recurrence.

Diagnostic Performance of [18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients

“…During the full text review of the remaining 372 articles, 269 were considered ineligible based on the above-mentioned selection criteria. Finally, 100 studies [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ...…”

“… Forest plots for the pooled sensitivity and specificity calculation for secondary staging at the patient level. Horizontal lines represent 95% confidence intervals of the individual studies [ 14 , 16 , 17 , 19 , 21 , 22 , 23 , 40 , 54 , 60 , 65 , 66 , 67 , 69 , 71 , 72 , 75 , 78 , 91 , 97 , 101 , 108 ]. …”

“…During the full text review of the remaining 372 articles, 269 were considered ineligible based on the above-mentioned selection criteria. Finally, 100 studies were found to be eligible to enter the meta-analytic calculations, including 82 patient-based datasets [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]33 [29][30][31][32]34,37,38,45,47,50,51,55,60,61,63,64,68,76,79,80,84,87,92,96,98,102,[104][105][106]. In total, 10,403 patients and 6188 lesions entered the final population.…”

Case report: Malignant melanoma of the lower limb with gastric metastasis

“…Generally, patients with metastatic MM of the stomach have atypical clinical symptoms ( 11 ), including abdominal distension, acid reflux, and other symptoms, as well as complications such as bleeding and perforation ( 12 ). They are easy to be confused with various benign and malignant diseases of the digestive tract, resulting in missed diagnosis and misdiagnosis and missing the best treatment period ( 13 ). Therefore, if the patient has a history of surgical resection of “melanoma” in the past, finds black tumors in the skin and mucosa during physical examination, and is hospitalized due to digestive system symptoms, MM should be highly suspected.…”

The role of imaging and sentinel lymph node biopsy in patients with T3b-T4b melanoma with clinically negative disease

“…Previous studies have established the value of cross-sectional imaging, particularly PET and PET/CT, in the staging of malignant melanoma. It has been previously demonstrated that the use of PET/CT is highly diagnostic for the evaluation of N-and M-staging, response to therapy and recurrence (15)(16)(17)(18). Additionally, a metaanalysis by Schroer-Gunther et al demonstrated increasing prognostic accuracy with increasing stage in the use of crosssectional imaging (19).…”