Skip to main content
SpringerLink
Log in

Utility of Preoperative 18F-FDG PET/CT and Brain MRI in Melanoma Patients with Palpable Lymph Node Metastases

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aims of this prospective study were to determine the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and brain MRI in melanoma patients with palpable lymph node metastases and to assess the impact of these imaging modalities on their management.

Materials and Methods

Between October 2006 and March 2009, PET/CT and brain MRI were performed in 70 melanoma patients with palpable nodal lymph node metastases and without evidence of systemic dissemination after physical examination. Hypermetabolic PET/CT lesions were examined by histology or cytology or were imaged further and followed if no pathology confirmation could be obtained.

Results

PET/CT findings changed the intended regional node dissection in 26 patients (37%). PET/CT was false negative in 4 patients (6%) and false positive in 1 (1%). This resulted in a sensitivity of 87%, specificity of 98%, accuracy of 93%, positive predictive value of 96%, and negative predictive value of 91%. MRI revealed brain metastases in 5 patients (7%). The overall survival of patients without additional lesions on PET/CT was 84% after 2 years, which was better than the 56% in patients with additional metastases (P < .001).

Conclusions

PET/CT has an 87% sensitivity and 98% specificity in the detection of other metastases in melanoma patients with palpable lymph node involvement. PET/CT leads to a change in the planned regional node dissection in 37% of the patients in this study. MRI revealed brain metastases in 5 patients (7%). PET/CT findings correlate with survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Balch CM, Soong SJ, 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;19:3622–34.

    CAS  PubMed  Google Scholar 

  2. Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87:892–901.

    Article  CAS  PubMed  Google Scholar 

  3. Reintgen DS, Cox C, Slingluff CL, Jr., Seigler HF. Recurrent malignant melanoma: the identification of prognostic factors to predict survival. Ann Plast Surg. 1992;28:45–9.

    Article  CAS  PubMed  Google Scholar 

  4. Soong SJ, Harrison RA, McCarthy WH, Urist MM, Balch CM. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J Surg Oncol. 1998;67:228–33.

    Article  CAS  PubMed  Google Scholar 

  5. Mijnhout GS, Hoekstra OS, van Tulder MW, Teule GJ, Deville WL. Systematic review of the diagnostic accuracy of (18)F-fluorodeoxyglucose positron emission tomography in melanoma patients. Cancer. 2001;91:1530–42.

    Article  CAS  PubMed  Google Scholar 

  6. Fink AM, Holle-Robatsch S, Herzog N, Mirzaei S, Rappersberger K, Lilgenau N, et al. Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II. Melanoma Res. 2004;14:141–5.

    Article  PubMed  Google Scholar 

  7. Wagner JD, Schauwecker D, Davidson D, Logan T, Coleman JJ 3rd, Hutchins G, et al. Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer. 2005;104:570–9.

    Article  PubMed  Google Scholar 

  8. Friedman KP, Wahl RL. Clinical use of positron emission tomography in the management of cutaneous melanoma. Semin Nucl Med. 2004;34:242–53.

    Article  PubMed  Google Scholar 

  9. Ho Shon IA, Chung DK, Saw RP, Thompson JF. Guidelines for imaging in cutaneous melanoma. Nucl Med Commun. 2008;29:877–9.

    Article  PubMed  Google Scholar 

  10. Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.

    Article  PubMed  Google Scholar 

  11. Pelosi E, Messa C, Sironi S, Picchio M, Landoni C, Bettinardi V, et al. Value of integrated PET/CT for lesion localisation in cancer patients: a comparative study. Eur J Nucl Med Mol Imaging. 2004;31:932–9.

    Article  PubMed  Google Scholar 

  12. Reinhardt MJ, Joe AY, Jaeger U, Huber A, Matthies A, Bucerius J, et al. Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N- and M-staging of malignant melanoma: experience with 250 consecutive patients. J Clin Oncol. 2006;24:1178–87.

    Article  PubMed  Google Scholar 

  13. Krug B, Crott R, Lonneux M, Baurain JF, Pirson AS, Vander Borght T. Role of PET in the initial staging of cutaneous malignant melanoma: systematic review. Radiology. 2008;249:836–44.

    Article  PubMed  Google Scholar 

  14. Kitajima K, Nakamoto Y, Okizuka H, Onishi Y, Senda M, Suganuma N, et al. Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors. Ann Nucl Med. 2008;22:595–602.

    Article  PubMed  Google Scholar 

  15. Rohren EM, Provenzale JM, Barboriak DP, Coleman RE. Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy. Radiology. 2003;226:181–7.

    Article  PubMed  Google Scholar 

  16. Bastiaannet E, Oyen WJ, Meijer S, Hoekstra OS, Wobbes T, Jager PL, et al. Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg. 2006;93:243–9.

    Article  CAS  PubMed  Google Scholar 

  17. Brady MS, Akhurst T, Spanknebel K, Hilton S, Gonen M, Patel A, et al. Utility of preoperative [18F] fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients. Ann Surg Oncol. 2006;13:525–32.

    Article  PubMed  Google Scholar 

  18. 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;28:961–5.

    Article  PubMed  Google Scholar 

  19. Horn J, Lock-Andersen J, Sjostrand H, Loft A. Routine use of FDG-PET scans in melanoma patients with positive sentinel node biopsy. Eur J Nucl Med Mol Imaging. 2006;33:887–92.

    Article  PubMed  Google Scholar 

  20. Bastiaannet E, Wobbes T, Hoekstra OS, van der Jagt EJ, Brouwers AH, Koelemij R, et al. Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: Diagnostic accuracy and impact on treatment. J Clin Oncol. 2009;27:4774–80.

    Article  PubMed  Google Scholar 

  21. Pfannenberg C, Aschoff P, Schanz S, Eschmann SM, Plathow C, Eigentler TK, et al. Prospective comparison of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer. 2007;43:557–64.

    Article  PubMed  Google Scholar 

  22. Falk MS, Truitt AK, Coakley FV, Kashani-Sabet M, Hawkins RA, Franc B. Interpretation, accuracy and management implications of FDG PET/CT in cutaneous malignant melanoma. Nucl Med Commun. 2007;28:273–80.

    Article  CAS  PubMed  Google Scholar 

  23. Singh B, Ezziddin S, Palmedo H, Reinhardt M, Strunk H, Tüting T, et al. Preoperative 18F-FDG-PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma. Melanoma Res. 2008;18:346–52.

    Article  PubMed  Google Scholar 

  24. Veit-Haibach P, Vogt FM, Jablonka R, Kuehl H, Bockisch A, Beyer T, et al. Diagnostic accuracy of contrast-enhanced FDG-PET/CT in primary staging of cutaneous malignant melanoma. Eur J Nucl Med Mol Imaging. 2009;36:910–8.

    Article  PubMed  Google Scholar 

  25. Strobel K, Dummer R, Husarik DB, Perez Lago M, Hany TF, et al. High-risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology. 2007;244:566–74.

    Article  PubMed  Google Scholar 

  26. Clark PB, Soo V, Kraas J, Shen P, Levine EA. Futility of fluorodeoxyglucose F 18 positron emission tomography in initial evaluation of patients with T2 to T4 melanoma. Arch Surg. 2006;141:284–8.

    Article  PubMed  Google Scholar 

  27. Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, et al. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med. 2000;41:1491–4.

    CAS  PubMed  Google Scholar 

  28. Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol. 1999;44:275–81.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Tjeerd S. Aukema MD, Renato A. Valdés Olmos MD, PhD & Wouter V. Vogel MD, PhD

  2. Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Michel W. J. M. Wouters MD, Bin B. R. Kroon MD, PhD & Omgo E. Nieweg MD, PhD

  3. Department of Head and Neck Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    W. Martin C. Klop MD, PhD

Authors
  1. Tjeerd S. Aukema MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renato A. Valdés Olmos MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel W. J. M. Wouters MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Martin C. Klop MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bin B. R. Kroon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wouter V. Vogel MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Omgo E. Nieweg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tjeerd S. Aukema MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aukema, T.S., Valdés Olmos, R.A., Wouters, M.W.J.M. et al. Utility of Preoperative 18F-FDG PET/CT and Brain MRI in Melanoma Patients with Palpable Lymph Node Metastases. Ann Surg Oncol 17, 2773–2778 (2010). https://doi.org/10.1245/s10434-010-1088-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1088-y

Keywords

Search

Navigation