The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma. (December 2020)

• Record Type: Journal Article
• Authors: Ravichandran, Surya; Nath, Neel; Jones, David C.; Li, Gabriel; Suresh, Visakha; Brys, Adam K.; Hanks, Brent A.; Beasley, Georgia M.; Salama, April K.S.; Howard, Brandon A.; Mosca, Paul J.
• Is Part Of: Surgical oncology. Volume 35(2020)
• Page Start: 533
• Page End: 539
• Publication Date: 2020-12
• Subjects: Positron emission tomography -- Computed tomography -- Melanoma -- Malignant melanoma -- Melanoma staging -- Magnetic resonance imaging; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2020.10.018
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma. Methods: A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed. Results: Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively. Conclusions: These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease. Highlights: Baseline staging PET-CT in stage II and III melanoma patients rarely changed initial management. The primary value of an initial PET-CT was that it served as a baseline for subsequent surveillance scans. A large majority of patients who underwent initial staging with PET/CT were subsequently monitored with ongoing cross-sectional imaging surveillance. The majority of melanoma recurrences were detected by cross-sectional surveillance imaging.