PET/CT in the management of patients with stage IIIC and IV metastatic melanoma considered candidates for surgery: evaluation of the additive value after conventional imaging

AJR Am J Roentgenol. 2012 Apr;198(4):902-8. doi: 10.2214/AJR.11.7280.

Abstract

Objective: The purpose of this article is to determine how often unexpected (18)F-FDG PET/CT findings result in a change in management for patients with stage IV and clinically evident stage III melanoma with resectable disease according to conventional imaging.

Subjects and methods: Thirty-two patients with oligometastatic stage IV and clinically evident stage III melanoma were identified by surgical oncologists according to the results of conventional imaging, which included contrast-enhanced CT of the chest, abdomen, and pelvis and MRI of the brain. The surgical plan included resection of known metastases or isolated limb perfusion with chemotherapy. Thirty-three FDG PET/CT scans were performed within 36 days of their contrast-enhanced CT. The impact of PET/CT was defined as the percentage of cases in which a change in the surgical plan resulted from the unanticipated PET/CT findings.

Results: PET/CT revealed unexpected melanoma metastases in 12% of scans (4/33). As a result, the surgery was canceled for two patients, and the planned approach was altered for another two patients to address the unexpected sites. In 6% of scans (2/33), the unexpected metastases were detected in the extremities, which were not included in conventional imaging. Three scans (9%) showed false-positive FDG-avid findings that proved to be benign by subsequent stability or resolution with no therapy.

Conclusion: In patients with surgically treatable metastatic melanoma, FDG PET/CT can detect unexpected metastases that are missed or not imaged with conventional imaging, and can be considered as part of preoperative workup.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / diagnostic imaging*
  • Melanoma / pathology
  • Melanoma / therapy*
  • Middle Aged
  • Multimodal Imaging*
  • Neoplasm Metastasis / diagnostic imaging*
  • Neoplasm Metastasis / pathology
  • Neoplasm Metastasis / therapy
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Prospective Studies
  • Tomography, X-Ray Computed

Substances

  • Contrast Media