Positron emission tomography/computed tomography imaging in Merkel cell carcinoma: A study of 270 scans in 97 patients at the Dana-Farber/Brigham and Women's Cancer Center

• Published in: Journal of the American Academy of Dermatology Vol. 68; no. 4; pp. 592 - 599
• Main Authors: Hawryluk, Elena B., MD, PhD, O'Regan, Kevin N., MB, FFRRCSI, Sheehy, Niall, MB, FFRRCSI, Guo, Ye, MSc, Dorosario, Andrew, BA, Sakellis, Christopher G., MD, Jacene, Heather A., MD, Wang, Linda C., MD, JD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2013
• Subjects: 2-fluoro-[18F]-deoxy-2-D-glucose; Adult; Aged; Aged, 80 and over; Carcinoma, Merkel Cell - diagnostic imaging; computed tomography; Dermatology; Female; Humans; imaging; Male; Merkel cell carcinoma; metastasis; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Retrospective Studies; Skin Neoplasms - diagnostic imaging; staging; Tomography, X-Ray Computed; computed tomography; magnetic resonance imaging; sentinel lymph node biopsy; 2-fluoro-[ 18F]-deoxy-2-D-glucose; Merkel cell carcinoma; MRI; SUV max; FDG; Dana-Farber/Brigham and Women's Cancer Center; SLNB; MCC; imaging; CT; DF/BWCC; fluorine-18; American Joint Committee on Cancer; metastasis; AJCC; positron emission tomography; staging; PET; maximum standardized uptake value; 18F; SUVmax; 2-fluoro-[18F]-deoxy-2-D-glucose
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2012.08.042

Background Merkel cell carcinoma (MCC) is a rare and lethal cutaneous neuroendocrine carcinoma. Imaging is crucial for accurate staging, which remains a strong predictor of survival, as well as earlier detection of recurrence and progression, which are common despite aggressive management. There is no consensus on the role of initial and subsequent imaging for MCC. Objective We sought to evaluate the use of 2-fluoro-[18 F]-deoxy-2-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in the management of MCC. Methods In all, 270 FDG-PET/CT studies were performed in 97 patients with pathology-proven MCC at the Dana-Farber/Brigham and Women's Cancer Center, Boston, Mass, from August 2003 to December 2010. Results FDG-PET/CT scans were obtained as part of the initial (61 scans in 61 patients) and subsequent (209 scans in 79 patients) treatment strategies. MCCs were FDG-avid with a mean maximum standardized uptake value of primary lesions of 6.5 (range 1.3-12.9) and a mean maximum standardized uptake value of regional and distant metastases of 7.2 (range 1.5-9.9). FDG-PET/CT upstaged 16% of patients who underwent baseline scans. FDG-PET/CT studies showed that bone and bone-marrow metastases were more common than previously reported, and were often undetected by CT. Limitations Our study is limited by its retrospective design, and potential referral bias associated with a tertiary care center. Conclusions FDG-PET/CT performed as part of the initial management strategy tended to upstage patients with more advanced disease. FDG-PET/CT performed as part of the subsequent treatment strategy identified metastatic disease, particularly in bone/bone marrow, which was not seen on CT. FDG-PET/CT imaging is a valuable staging and restaging tool in MCC management.