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Tailoring surveillance imaging in uveal melanoma based on individual metastatic risk

  • 0Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden.
Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie +

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August 16, 2024

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August 16, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Personalized surveillance for uveal melanoma (UM) patients, based on metastatic risk, can optimize follow-up schedules. This approach uses the number needed to scan (NNS) to tailor examinations, reducing unnecessary tests and improving resource allocation for high-risk individuals.

Area Of Science

  • Ophthalmology
  • Oncology
  • Medical Surveillance

Background

  • Uveal melanoma (UM) is the most common primary intraocular malignancy.
  • Current surveillance protocols for UM patients often lack personalization, leading to inefficient resource allocation and potentially missed metastatic disease.
  • Metastatic risk varies significantly among UM patients based on prognostic factors.

Purpose Of The Study

  • To develop tailored surveillance programs for uveal melanoma (UM) patients.
  • To optimize surveillance schedules based on individual metastatic risk.
  • To improve the efficiency and effectiveness of post-treatment monitoring for UM.

Main Methods

  • Developed surveillance schedules using the number needed to scan (NNS) concept.
  • Utilized weighted average metastasis-free survival (MFS) rates from a systematic review of 18 prognostic groups.
  • Included factors such as cytogenetics (Disomy 3, Monosomy 3), mutations (EIF1AX, SF3B1, BAP1), immunohistochemistry, gene expression profiling (GEP) classes, and tumor stage.

Main Results

  • NNS varied dramatically in typical surveillance schedules, highlighting the need for personalized approaches.
  • Recommended first surveillance examination timing ranged from 3 months to 5 years postdiagnosis based on NNS.
  • An NNS 20 strategy required an average of 10 examinations, with significant variation based on prognostic group (e.g., 2 for Disomy 3 vs. up to 17 for GEP class 2PRAME+).
  • Under an NNS 20 protocol, 1-2% of examinations were anticipated to lead to effective metastatic disease treatment.

Conclusions

  • Customizing UM surveillance to metastatic risk can transform current practices.
  • Personalized protocols ensure more precise monitoring, reducing unnecessary examinations.
  • This approach allows for better direction of healthcare resources to patients with the greatest need.