Positron emission tomography scanning in malignant melanoma

Clinical utility in patients with Stage III disease

Douglas Tyler, Mark Onaitis, Aftab Kherani, Ankie Hata, Evelyn Nicholson, Mary Keogan, Samuel Fisher, Edward Coleman, Hiliard F. Seigler

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

BACKGROUND. Several recent studies have demonstrated the low yield of anatomically based computed tomography scans in evaluating Stage III (American Joint Committee on Cancer) patients with malignant melanoma. The purpose of this study was to investigate the efficacy and clinical utility of functionally based positron emission tomography (PET) scans in the same patient population. METHODS. A prospective evaluation of 106 whole body PET scans obtained after injection of 2-fluorine-18, 2-fluoro-2-deoxy-D-glucose (FDG) was performed in 95 patients with clinically evident Stage III lymph node and/or in-transit melanoma. Areas of abnormality on FDG PET scanning were identified visually as foci of increased metabolic activity compared with background, and all positive loci were assessed pathologically. RESULTS. In this patient population, there were 234 areas that were evaluated pathologically of which 165 were confirmed histologically to be melanoma. PET scanning identified 144 of the 165 areas of melanoma for a sensitivity of 87.3%. The 21 areas of melanoma that were missed included 10 microscopic foci, 9 foci less than 1 cm, and 2 foci greater than 1 cm. There were 39 areas of increased PET activity that were not associated with malignancy for a 78.6% predictive value of a positive test. Of the 39 false-positive areas (false-positive rate of 56.5%), 13 could be attributed to recent surgery, 3 to arthritis, 3 to infection, 2 to superficial phlebitis, 1 to a benign skin nevus, and 1 to a colonic polyp. Pathologic evaluation of the remaining false-positive areas failed to reveal a definitive etiology for their increased activity on PET scan. With the application of pertinent clinical information, the predictive value of a positive PET scan could be improved to 90.6%. The specificity of PET scanning in this study was only 43.5% because very few prophylactic lymph node dissections were performed. Thirty-six of the total 183 abnormal areas (19.7%) on PET scanning proved to be unsuspected areas of metastatic disease. These findings led to a change in the planned clinical management in patients after 16 of the 106 PET scans (15.1%). CONCLUSIONS. FDG PET scanning can be helpful in managing patients with Stage III melanoma in whom further surgery is contemplated. Although false-positive areas are not uncommon, PET scans did change the management of patients 15% of the time. PET's inability to identify microscopic disease suggests that it is of limited use in evaluating patients with Stage I-II disease. (C) 2000 American Cancer Society.

Original languageEnglish (US)
Pages (from-to)1019-1025
Number of pages7
JournalCancer
Volume89
Issue number5
DOIs
StatePublished - Sep 1 2000
Externally publishedYes

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Positron-Emission Tomography
Melanoma
Deoxyglucose
Colonic Polyps
Phlebitis
Fluorine
Nevus
Fluorodeoxyglucose F18
Lymph Node Excision
Population
Arthritis
Neoplasms
Lymph Nodes
Tomography
Skin
Injections

Keywords

  • 2-fluorine-18
  • 2-fluoro-2-deoxy-D-glucose (FDG)
  • In-transit disease
  • Melanoma
  • Metastatic
  • Positron emission tomography (PET) scan

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Positron emission tomography scanning in malignant melanoma : Clinical utility in patients with Stage III disease. / Tyler, Douglas; Onaitis, Mark; Kherani, Aftab; Hata, Ankie; Nicholson, Evelyn; Keogan, Mary; Fisher, Samuel; Coleman, Edward; Seigler, Hiliard F.

In: Cancer, Vol. 89, No. 5, 01.09.2000, p. 1019-1025.

Research output: Contribution to journalArticle

Tyler, D, Onaitis, M, Kherani, A, Hata, A, Nicholson, E, Keogan, M, Fisher, S, Coleman, E & Seigler, HF 2000, 'Positron emission tomography scanning in malignant melanoma: Clinical utility in patients with Stage III disease', Cancer, vol. 89, no. 5, pp. 1019-1025. https://doi.org/10.1002/1097-0142(20000901)89:5<1019::AID-CNCR11>3.0.CO;2-0
Tyler, Douglas ; Onaitis, Mark ; Kherani, Aftab ; Hata, Ankie ; Nicholson, Evelyn ; Keogan, Mary ; Fisher, Samuel ; Coleman, Edward ; Seigler, Hiliard F. / Positron emission tomography scanning in malignant melanoma : Clinical utility in patients with Stage III disease. In: Cancer. 2000 ; Vol. 89, No. 5. pp. 1019-1025.
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abstract = "BACKGROUND. Several recent studies have demonstrated the low yield of anatomically based computed tomography scans in evaluating Stage III (American Joint Committee on Cancer) patients with malignant melanoma. The purpose of this study was to investigate the efficacy and clinical utility of functionally based positron emission tomography (PET) scans in the same patient population. METHODS. A prospective evaluation of 106 whole body PET scans obtained after injection of 2-fluorine-18, 2-fluoro-2-deoxy-D-glucose (FDG) was performed in 95 patients with clinically evident Stage III lymph node and/or in-transit melanoma. Areas of abnormality on FDG PET scanning were identified visually as foci of increased metabolic activity compared with background, and all positive loci were assessed pathologically. RESULTS. In this patient population, there were 234 areas that were evaluated pathologically of which 165 were confirmed histologically to be melanoma. PET scanning identified 144 of the 165 areas of melanoma for a sensitivity of 87.3{\%}. The 21 areas of melanoma that were missed included 10 microscopic foci, 9 foci less than 1 cm, and 2 foci greater than 1 cm. There were 39 areas of increased PET activity that were not associated with malignancy for a 78.6{\%} predictive value of a positive test. Of the 39 false-positive areas (false-positive rate of 56.5{\%}), 13 could be attributed to recent surgery, 3 to arthritis, 3 to infection, 2 to superficial phlebitis, 1 to a benign skin nevus, and 1 to a colonic polyp. Pathologic evaluation of the remaining false-positive areas failed to reveal a definitive etiology for their increased activity on PET scan. With the application of pertinent clinical information, the predictive value of a positive PET scan could be improved to 90.6{\%}. The specificity of PET scanning in this study was only 43.5{\%} because very few prophylactic lymph node dissections were performed. Thirty-six of the total 183 abnormal areas (19.7{\%}) on PET scanning proved to be unsuspected areas of metastatic disease. These findings led to a change in the planned clinical management in patients after 16 of the 106 PET scans (15.1{\%}). CONCLUSIONS. FDG PET scanning can be helpful in managing patients with Stage III melanoma in whom further surgery is contemplated. Although false-positive areas are not uncommon, PET scans did change the management of patients 15{\%} of the time. PET's inability to identify microscopic disease suggests that it is of limited use in evaluating patients with Stage I-II disease. (C) 2000 American Cancer Society.",
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T2 - Clinical utility in patients with Stage III disease

AU - Tyler, Douglas

AU - Onaitis, Mark

AU - Kherani, Aftab

AU - Hata, Ankie

AU - Nicholson, Evelyn

AU - Keogan, Mary

AU - Fisher, Samuel

AU - Coleman, Edward

AU - Seigler, Hiliard F.

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N2 - BACKGROUND. Several recent studies have demonstrated the low yield of anatomically based computed tomography scans in evaluating Stage III (American Joint Committee on Cancer) patients with malignant melanoma. The purpose of this study was to investigate the efficacy and clinical utility of functionally based positron emission tomography (PET) scans in the same patient population. METHODS. A prospective evaluation of 106 whole body PET scans obtained after injection of 2-fluorine-18, 2-fluoro-2-deoxy-D-glucose (FDG) was performed in 95 patients with clinically evident Stage III lymph node and/or in-transit melanoma. Areas of abnormality on FDG PET scanning were identified visually as foci of increased metabolic activity compared with background, and all positive loci were assessed pathologically. RESULTS. In this patient population, there were 234 areas that were evaluated pathologically of which 165 were confirmed histologically to be melanoma. PET scanning identified 144 of the 165 areas of melanoma for a sensitivity of 87.3%. The 21 areas of melanoma that were missed included 10 microscopic foci, 9 foci less than 1 cm, and 2 foci greater than 1 cm. There were 39 areas of increased PET activity that were not associated with malignancy for a 78.6% predictive value of a positive test. Of the 39 false-positive areas (false-positive rate of 56.5%), 13 could be attributed to recent surgery, 3 to arthritis, 3 to infection, 2 to superficial phlebitis, 1 to a benign skin nevus, and 1 to a colonic polyp. Pathologic evaluation of the remaining false-positive areas failed to reveal a definitive etiology for their increased activity on PET scan. With the application of pertinent clinical information, the predictive value of a positive PET scan could be improved to 90.6%. The specificity of PET scanning in this study was only 43.5% because very few prophylactic lymph node dissections were performed. Thirty-six of the total 183 abnormal areas (19.7%) on PET scanning proved to be unsuspected areas of metastatic disease. These findings led to a change in the planned clinical management in patients after 16 of the 106 PET scans (15.1%). CONCLUSIONS. FDG PET scanning can be helpful in managing patients with Stage III melanoma in whom further surgery is contemplated. Although false-positive areas are not uncommon, PET scans did change the management of patients 15% of the time. PET's inability to identify microscopic disease suggests that it is of limited use in evaluating patients with Stage I-II disease. (C) 2000 American Cancer Society.

AB - BACKGROUND. Several recent studies have demonstrated the low yield of anatomically based computed tomography scans in evaluating Stage III (American Joint Committee on Cancer) patients with malignant melanoma. The purpose of this study was to investigate the efficacy and clinical utility of functionally based positron emission tomography (PET) scans in the same patient population. METHODS. A prospective evaluation of 106 whole body PET scans obtained after injection of 2-fluorine-18, 2-fluoro-2-deoxy-D-glucose (FDG) was performed in 95 patients with clinically evident Stage III lymph node and/or in-transit melanoma. Areas of abnormality on FDG PET scanning were identified visually as foci of increased metabolic activity compared with background, and all positive loci were assessed pathologically. RESULTS. In this patient population, there were 234 areas that were evaluated pathologically of which 165 were confirmed histologically to be melanoma. PET scanning identified 144 of the 165 areas of melanoma for a sensitivity of 87.3%. The 21 areas of melanoma that were missed included 10 microscopic foci, 9 foci less than 1 cm, and 2 foci greater than 1 cm. There were 39 areas of increased PET activity that were not associated with malignancy for a 78.6% predictive value of a positive test. Of the 39 false-positive areas (false-positive rate of 56.5%), 13 could be attributed to recent surgery, 3 to arthritis, 3 to infection, 2 to superficial phlebitis, 1 to a benign skin nevus, and 1 to a colonic polyp. Pathologic evaluation of the remaining false-positive areas failed to reveal a definitive etiology for their increased activity on PET scan. With the application of pertinent clinical information, the predictive value of a positive PET scan could be improved to 90.6%. The specificity of PET scanning in this study was only 43.5% because very few prophylactic lymph node dissections were performed. Thirty-six of the total 183 abnormal areas (19.7%) on PET scanning proved to be unsuspected areas of metastatic disease. These findings led to a change in the planned clinical management in patients after 16 of the 106 PET scans (15.1%). CONCLUSIONS. FDG PET scanning can be helpful in managing patients with Stage III melanoma in whom further surgery is contemplated. Although false-positive areas are not uncommon, PET scans did change the management of patients 15% of the time. PET's inability to identify microscopic disease suggests that it is of limited use in evaluating patients with Stage I-II disease. (C) 2000 American Cancer Society.

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KW - Melanoma

KW - Metastatic

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