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FDG PET in early stage cutaneous malignant melanoma
Jody McIvor1, Teck Siew, Andrew Campbell
1Department of Nuclear Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Introduction:
Fluorodeoxyglucose positron emission tomography (FDG PET) is not recommended in early stage melanoma; however, a significant number of cases are referred to our institution for FDG PET. We refer to early stage disease as American Joint Committee on Cancer (AJCC) stage I and II, which includes all cases without metastases. A retrospective review was undertaken to determine the clinical utility of FDG PET in this patient group.
Methods:
A retrospective study of FDG scans on all patients presenting to the WA PET Centre with early stage melanoma over a 5½ year period was undertaken. The positivity rate of the initial study for detection of malignant melanoma was determined. In patients with an initially negative FDG PET, the time from initial diagnosis to a positive surveillance study was determined. Both the initial positivity rate and time to a positive study were correlated with Breslow staging.
Results:
Three hundred twenty-two patients were included in the study, of which 74 had initial positive FDG PET scans (23%). Adequate follow-up was available in 51 patients with the PET result confirmed as true positive in 37 (positive predictive value 73%). One hundred eight of 248 patients initially negative had follow-up scans during the follow-up period, of which 48 became positive. The 73% of recurrences were over 12 months post-diagnosis. No correlation with Breslow thickness was demonstrated.
Conclusion:
Despite FDG PET not being recommended for early cutaneous malignant melanoma, 27% of melanoma cases referred for FDG PET during the study period were AJCC stage I or II. Our results suggest FDG PET in early stage melanoma demonstrates occult disease in 17% of cases.
Insights
Despite recommendations against its use, fluorodeoxyglucose positron emission tomography (FDG PET) identified occult disease in 17% of early-stage melanoma patients. This study evaluated the clinical utility of FDG PET in AJCC stages I and II melanoma.
Area of Science:
- Oncology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Fluorodeoxyglucose positron emission tomography (FDG PET) is not routinely recommended for early-stage melanoma (AJCC stages I-II).
- Despite this, a notable number of early-stage melanoma patients are referred for FDG PET scans.
- This study aimed to assess the clinical utility of FDG PET in this specific patient group.
Purpose of the Study:
- To determine the clinical utility of FDG PET in patients with early-stage melanoma (AJCC stages I and II).
- To evaluate the rate of occult disease detection by FDG PET in this population.
Main Methods:
- A retrospective review of FDG PET scans was conducted for patients with early-stage melanoma over 5.5 years.
- The study analyzed the initial positivity rate of FDG PET for detecting malignant melanoma.
- Follow-up data was used to determine the time to positive surveillance studies and correlate findings with Breslow staging.
Main Results:
- Out of 322 patients, 74 (23%) had initially positive FDG PET scans, with a positive predictive value of 73% for confirmed true positives.
- Among 248 patients with initially negative scans, 48 (approx. 19%) later showed positive results on follow-up, with most recurrences occurring over 12 months post-diagnosis.
- No significant correlation was found between FDG PET findings and Breslow thickness.
Conclusions:
- FDG PET identified occult disease in 17% of early-stage melanoma cases referred for the scan.
- Despite current recommendations, FDG PET may have a role in detecting unexpected disease in select early-stage melanoma patients.
- Further investigation into the precise role and timing of FDG PET in early melanoma management is warranted.
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