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From the Surgery Branch, Center for Cancer Research, National Cancer Institute (SEF, DEW, SAR, RMS), Department of Nuclear Medicine, Warren Grant Magnuson Clinical Center (JAC, BG), Molecular Imaging Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute (JMH), and Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center (PC), National Institutes of Health, Bethesda, Maryland.
Correspondence: Address correspondence and reprint requests to: Richard M. Sherry, MD, Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 2338, 9000 Rockville Pike, Bethesda, MD 20892; Fax: 301-402-0922; E-mail: richard_sherry{at}nih.gov
Background: Positron emission tomography with 2-deoxy-2-[18F]fluoro-D-glucose (FDG-PET) is available for evaluation of patients with melanoma. This study evaluates the potential of FDG-PET to improve on conventional imaging (CI) in patients with stage IV melanoma undergoing metastasectomy.
Methods: This was a prospective study comparing radiological evaluation of patients who underwent metastasectomy for palliation or cure. Patients underwent preoperative evaluation by physical examination, CI by computed tomography and/or magnetic resonance imaging, and FDG-PET. Independent observers performed three separate analyses of CI alone, FDG-PET alone, or FDG-PET read with knowledge of CI (FDG-PET + CI). Abnormalities were reported as benign or malignant and assessed by pathologic analysis or by clinical outcome determined by disease progression detected on serial evaluations.
Results: Ninety-four lesions were noted in 18 patients who underwent preoperative assessment, metastasectomy, and long-term follow up (median, 24 months). Lesion-by-lesion analysis for CI demonstrated a sensitivity of 76%, a specificity of 87%, a positive predictive value (PPV) of 86%, and a negative predictive value (NPV) of 76%. FDG-PET demonstrated a sensitivity of 79%, a specificity of 87%, a PPV of 86%, and an NPV of 80%. For FDG-PET + CI, the sensitivity was 88%, specificity was 91%, and PPV and NPV were 91% and 88%, respectively.
Conclusions: Combined use of FDG-PET and CI may be an accurate strategy to identify sites of disease in patients with stage IV melanoma being considered for metastasectomy. Interpreted independently, FDG-PET and CI seemed to be equivalent modalities. FDG-PET + CI had both the highest sensitivity on lesion-by-lesion analysis and the best accuracy on patient-by-patient analysis.
Key Words: Melanoma • Cancer • FDG-PET • Imaging • Metastasectomy • Surgery
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