Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Helvind, Neel Maria; Aros Mardones, Catalina Aurora; Hölmich, Lisbet Rosenkrantz; Hendel, Helle Westergren; Bidstrup, Pernille Envold; Sørensen, Jens Ahm; Chakera, Annette Hougaard
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 12(2021)
• Page Start: 3020
• Page End: 3027
• Publication Date: 2021-12
• Subjects: Melanoma -- Surveillance -- 18F-FDG PET-CT -- Asymptomatic recurrence -- Routine imaging; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.06.011
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. Materials and methods: Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. Results: In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). Conclusion: Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients. Highlights: Sensitivity of routine PET-CT was 100% and specificity was 94.7% Routine PET-CT detected recurrence in 18.1% of patients within 17.7 months PET-CT detected asymptomatic distant recurrence in 13.8% of patients Median time-to-recurrence was 6.8 months, indicating a gain of imaging at 6 months Results indicate a lower yield of early routine PET-CT in stage IIB patients