Adult; Aged; Disease Progression; Extremities/blood supply/pathology; False Positive Reactions; Female; Fluorodeoxyglucose F18/diagnostic use; Follow-Up Studies; Head and Neck Neoplasms/diagnosis/pathology; Humans; Injections, Intravenous; Lymph Nodes/pathology/radionuclide imaging/surgery; Male; Melanoma/diagnosis/pathology; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Radiopharmaceuticals/diagnostic use; Recurrence; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Tomography, Emission-Computed
Abstract :
[en] PRIMARY PURPOSE: The staging of regional nodes by means of sentinel node detection has been shown to accurately detect subclinical nodal metastases from cutaneous melanoma. On the other hand, the oncological applications of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG PET) are, nowadays, firmly established. However, the sensitivity of such metabolic imaging for staging the regional nodes in primary melanoma remains debatable. We prospectively assessed the actual value of PET for detecting sentinel node metastases in 21 consecutive patients presenting with early-stage melanoma. MATERIALS AND METHODS: Twenty-one melanoma patients scheduled for lymphatic mapping and sentinel lymphadenectomy underwent fully corrected whole-body PET using 18FDG. In all cases, the disease was initially classified as either stage I or II, from the latest version of the American Joint Committee on Cancer staging system. The sentinel node detection was systematically performed within the week following the PET scan. Serial sections of the sentinel nodes were analyzed by both conventional pathology and immunohistochemical staining. Metastatic sentinel nodes were also assessed for the size of tumor deposits and the degree of nodal involvement (focal, partial, or massive). The median follow-up time was 12 months. RESULTS: Six of the 21 patients (28.5%) had an involved sentinel node. PET was positive in only one case with a sentinel node >1 cm. In the five other cases, the sentinel nodes missed by PET were <1 cm with focal and/or partial involvements. One patient, free of regional nodal metastases in both sentinel node detection and PET imaging, had, however, a same-basin recurrence 3 months later. In another case, PET had one false positive result. Overall, the sentinel detection of subclinical nodal metastases had a sensitivity of 86%. PET detected only 14% of sentinel node metastases. CONCLUSIONS: Sentinel node detection remains the procedure of choice for detecting subclinical lymph node involvement from primary cutaneous melanoma. Owing to its limited spatial resolution, PET appears insufficiently sensitive to identify microscopic nodal metastases. As a practical consequence, metabolic imaging is not recommended as a first-line imaging strategy for staging regional lymph nodes in patients with stage I or II melanoma.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Belhocine, Tarik; Centre Hospitalier Universitaire de Liège - CHU > Médecine nucléaire
Pierard, Gérald ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
De Labrassinne, Michel; Centre Hospitalier Universitaire de Liège - CHU > Dermatologie
Lahaye, Thierry ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie générale
Rigo, Pierre ; Université de Liège - ULiège > Département des sciences de la motricité > Pathologie générale et médecine nucléaire
Language :
English
Title :
Staging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection.
Publication date :
2002
Journal title :
Oncologist
ISSN :
1083-7159
eISSN :
1549-490X
Publisher :
AlphaMed Company, Inc., Miamisburg, United States - Ohio
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
Landis S.H., Murray T., Bolden S. (1999) Cancer statistics, 1999. CA Cancer J Clin 49:8-31.
Reintgen D.S. (2000) Regional nodal surgery for melanoma impacts recurrence rates and survival. Ann Surg Oncol 7:80-81.
Balch C.M. (1988) The role of elective lymph node dissection in melanoma: Rationale, results, and controversies. J Clin Oncol 6:163-172.
Morton D.L., Chan A.D. (2000) The concept of sentinel node localization: How it started. Semin Nucl Med 30:4-10.
Reintgen D., Cruse C.W., Wells K. (1994) The orderly progression of melanoma nodal metastases. Ann Surg 220:759-767.
Morton D.L., Wen D.R., Wong J.H. (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392-399.
Morton D.L., Thompson J.F., Essner R. (1999) Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: A multicenter trial. Ann Surg , Multicenter Selective Lymphadenectomy Trial Group; 230:453-463.
Cochran A.J., Balda B.R., Starz H. (2000) The Augsburg Consensus. Techniques of lymphatic mapping, sentinel lymphadenectomy, and completion lymphadenectomy in cutaneous malignancies. Cancer 89:236-241.
Morton D.L. (2001) Lymphatic mapping and sentinel lymphadenectomy for melanoma: Past, present, and future. Ann Surg Oncol 8(SUPPL. 9).
Delbeke D. (1999) Oncological applications of FDG PET imaging. J Nucl Med 40:1706-1715.
Delbeke D. (1999) Oncological applications of FDG PET imaging: Brain tumors, colorectal cancer, lymphoma and melanoma. J Nucl Med 40:591-603.
Delbeke D., Martin W.H. (2001) Positron emission tomography imaging in oncology. Radiol Clin North Am 39:883-917.
Strauss L.G. (2000) Sensitivity and specificity of positron emission tomography (PET) for the diagnosis of lymph node metastases. Recent Results Cancer Res 157:12-19.
Gritters L.S., Francis I.R., Zasadny K.R. (1993) Initial assessment of positron emission tomography using 2-fluorine-18-fluoro-2- deoxy-D-glucose in the imaging of malignant melanoma. J Nucl Med 34:1420-1427.
Steinert H.C., Huch Boni R.A., Buck A. (1995) Malignant melanoma: Staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 195:705-709.
Boni R., Boni R.A., Steinert H. (1995) Staging of metastatic melanoma by whole-body positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose. Br J Dermatol 132:556-562.
Wagner J.D., Schauwecker D., Hutchins G. (1997) Initial assessment of positron emission tomography for detection of non-palpable regional lymphatic metastases in melanoma. J Surg Oncol 64:181-189.
Macfarlane D.J., Sondak V., Johnson T. (1998) Prospective evaluation of 2-[18F]-2-deoxy-D-glucose positron emission tomography in staging of regional lymph nodes in patients with cutaneous malignant melanoma. J Clin Oncol 16:1770-1776.
Wagner J.D., Schauwecker D., Davidson D. (1999) Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol 17:1508-1515.
Acland K.M., Healy C., Calonje E. (2001) Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. J Clin Oncol 19:2674-2678.
Acland K.M., O'Doherty M.J., Russell-Jones R. (2000) The value of positron emission tomography scanning in the detection of subclinical metastatic melanoma. J Am Acad Dermatol 42:606-611.
Wagner J.D., Schauwecker D.S., Davidson D. (2001) FDG-PET sensitivity for melanoma lymph node metastases is dependent on tumor volume. J Surg Oncol 77:237-234.
Kokoska M.S., Olson G., Kelemen P.R. (2001) The use of lymphoscintigraphy and PET in the management of head and neck melanoma. Otolaryngol Head Neck Surg 125:213-220.
Balch C.M., Buzaid A.C., Soong S.J. (2001) Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 19:3635-3648.
Kirkwood J.M., Strawderman M.H., Ernstoff M.S. (1996) Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: The Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol 14:7-17.
Gershenwald J.E., Thompson W., Mansfield P.F. (1999) Multi-institutional melanoma lymphatic mapping experience: The prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 17:976-983.
Tyler D.S., Onaitis M., Kherani A. (2000) Positron emission tomography scanning in malignant melanoma. Cancer 89:1019-1025.
Crippa F., Leutner M., Belli F. (2000) Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 41:1491-1494.
Raylman R.R., Kison P.V., Wahl R.L. (1999) Capabilities of two- and three-dimensional FDG-PET for detecting small lesions and lymph nodes in the upper torso: A dynamic phantom study. Eur J Nucl Med 26:39-45.
Wong T., Coleman R., Hagge R. (2000) PET image interpretation. Attenuation-corrected (ATN) vs non-attenuation corrected (NATN) images. Clin Positron Imaging 3:181.
Visvikis D., Cheze-LeRest C., Costa D.C. (2001) Influence of OSEM and segmented attenuation correction in the calculation of standardised uptake values for [18F]FDG PET. Eur J Nucl Med 28:1326-1335.
Karp J.S., Freifelder R., Geagan M.J. (1997) Three-dimensional imaging characteristics of the HEAD PENN-PET scanner. J Nucl Med 38:636-643.
Adam L.E., Karp J.S., Daube-Witherspoon M.E. (2001) Performance of a whole-body PET scanner using curve-plate NaI(TI) detectors. J Nucl Med 42:1821-1830.
Leahy R., Byrne C. (2000) Recent developments in iterative image reconstruction for PET and SPECT. IEEE Trans Med Imaging 19:257-260.
Knesaurek K. (2001) New developments in PET instrumentation: Quo vadis PET?. J Nucl Med 42:1831-1832.
Liu X., Comtat C., Michel C. (2001) Comparison of 3-D reconstruction with 3D-OSEM and with FORE+OSEM for PET. IEEE Trans Med Imaging 20:804-814.
Zaidi H. (2001) Scatter modelling and correction strategies in fully 3-D PET. Nucl Med Commun 22:1181-1184.
Adam L.E., Karp J.S., Freifelder R. (2000) Energy-based scatter correction for 3-D PET scanners using NaI(T1) detectors. IEEE Trans Med Imaging 19:513-521.
Shivers S.C., Wang X., Li W. (1998) Molecular staging of malignant melanoma: Correlation with clinical outcome. JAMA 280:1410-1415.
Sung J., Li W., Shivers S. (2001) Molecular analysis in evaluating the sentinel node in malignant melanoma. Ann Surg Oncol 8(SUPPL. 9).
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.