¹⁸F-FDG PET/CT in the detection of asymptomatic malignant melanoma recurrence

 

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Summary

Aim: To evaluate the diagnostic accuracy of FDG PET/CT in the detection of asymptomatic recurrence in patients with malignant melanoma who have had resection of their primary lesion. We also aimed to determine the pattern and factors predisposing to disease recurrence. Methods: Patients with malignant melanoma who have had surgical resection of their disease and without any clinical evidence of disease recurrence were followed- up with FDG PET/CT. The diagnostic accuracy of FDG PET/CT, pattern of recurrence and factors predictive of disease recurrence were determined. Results: A total of 144 patients were followed-up for a median period of 50.50 months. Asymptomatic recurrence was seen in 37 patients (25.7 %) with a median time to recurrence of 20 months. Lymph node was the commonest site of asymptomatic recurrence. Sex, tumour depth, histology type and presence of nodal metastasis were significant predictors of tumour recurrence. Age, race, site of primary lesion, type of lymph node resection were not significant predictors of disease recurrence. Race has a significant effect on the histological subtype of tumour (nodular maligna was more common in Caucasian while acral lentiginous was more prevalent in the Blacks) and the site of the primary lesion (lower limb in Blacks and trunk in Caucasians). Sensitivity, specificity and accuracy of FDG PET/CT for the detection of disease recurrence were 94.5 %, 87.6 % and 89.6 % respectively. Conclusion: FDG PET/CT is a suitable modality for early detection of asymptomatic recurrence of malignant melanoma. Asymptomatic recurrence most commonly occurs in lymph nodes. Sex, nodal metastasis and tumour pathologic features are predictors of recurrence.

Zusammenfassung

Ziel: Ziel der Studie war es, die diagnostischen Genauigkeit des FDG PET/CT beim Nachweis asymptomatischer Rezidive bei Patienten mit malignem Melanom zu untersuchen, deren Primärtumor reseziert wurde. Außerdem sollten das Muster und die für ein Krankheitsrezidiv prädisponierenden Faktoren ermittelt werden. Methoden: Patienten mit malignem Melanom, deren Tumor operativ entfernt wurde und die keine klinischen Anzeichen für ein Rezidiv aufwiesen, wurden mittels FDG PET/CT nachbeobachtet. Die diagnostische Genauigkeit des FDG PET/CT, das Rezidivmuster und die prognostischen Faktoren für ein Krankheitsrezidiv wurden ermittelt. Ergebnisse: Insgesamt wurden 144 Patienten über einen Zeitraum von durchschnittlich 50,5 Monaten nachbeobachtet. Ein asymptomatisches Rezidiv wurde bei 37 Patienten (25,7 %) festgestellt, im Durchschnitt betrug die Zeit bis zum Rezidiv 20 Monate. Die häufigste Lokalisation für ein asymptomatisches Rezidiv waren die Lymphknoten. Geschlecht, Tumortiefe, histologischer Typ und das Vorliegen von Lymphknotenmetastasen waren signifikante Prädiktoren für ein Tumorrezidiv. Alter, ethnische Herkunft, Lokalisation des Primärtumors und Art der Lymphknotenresektion waren nicht signifikante Prädiktoren für ein Krankheitsrezidiv. Die ethnische Herkunft hatte einen signifikanten Effekt auf den histologischen Subtyp des Tumors (das noduläre maligne Melanom trat häufiger bei Kaukasiern auf, das akrolentiginöse Melanom hatte eine höhere Prävalenz bei Schwarzen) und die Lokalisation des Primärtumors (untere Extremität bei Schwarzen, Rumpf bei Kaukasiern). Sensitivität, Spezifität und Genauigkeit des FDG PET/CT beim Nachweis eines Krankheitsrezidivs lagen bei 94,5 %, 87,6 % bzw. 89,6 %. Schlussfolgerung: Das FDG PET/CT eignet sich für den frühen Nachweis von asymptomatischen Rezidiven eines malignen Melanoms. Asymptomatische Rezidive treten am häufigsten in den Lymphknoten auf. Geschlecht, Lymphknotenmetastasen und tumorpathologische Merkmale sind Prädikto- ren für ein Rezidiv.

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