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

• Published in: Annals of surgical oncology Vol. 17; no. 10; pp. 2773 - 2778
• Main Authors: Aukema, Tjeerd S., Valdés Olmos, Renato A., Wouters, Michel W. J. M., Klop, W. Martin C., Kroon, Bin B. R., Vogel, Wouter V., Nieweg, Omgo E.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2010; Springer Nature B.V
• Subjects: Aged; Brain Neoplasms - diagnosis; Brain Neoplasms - surgery; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Magnetic Resonance Imaging - utilization; Male; Medicine; Medicine & Public Health; Melanoma - diagnosis; Melanoma - surgery; Melanomas; Middle Aged; Oncology; Positron-Emission Tomography - utilization; Preoperative Care; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Surgery; Surgical Oncology; Survival Rate; Tomography, X-Ray Computed - utilization; Treatment Outcome; Brain Metastasis; Melanoma Patient; Brain Magnetic Resonance Imaging; Palpable Lymph Node; Isolate Limb Perfusion
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1088-y

Background The aims of this prospective study were to determine the diagnostic value of 18 F-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.