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Clinical and Prognostic Value of 18F-FDG-PET/CT in the Restaging Process of Recurrent Cutaneous Melanoma

Author(s):

Domenico Albano, Demetrio Familiari, Maria Concetta Fornito, Salvatore Scalisi, Riccardo Laudicella, Massimo Galia, Emanuele Grassedonio, Antonella Ruggeri, Gloria Ganduscio, Marco Messina, Massimiliano Spada, Massimo Midiri and Pierpaolo Alongi*   Pages 1 - 6 ( 6 )

Abstract:


Objective: The aim of this retrospective multicenter study was to evaluate the clinical and prognostic impact of 18F-FDG-PET/CT in the restaging process of cutaneous melanoma (CM) after surgery in patients with suspected distant recurrent disease or suspected metastatic progression disease.

Materials and Methods: 74 patients surgically treated for CM underwent 18F-FDG-PET/CT for suspicious of distant recurrent disease or suspected metastatic progression disease. The diagnostic accuracy of visually interpreted 18F-FDG-PET/CT was obtained by considering histology (n=21 patients), other diagnostic imaging modalities performed within 2 months from PET/CT (CT in 52/74 patients and Whole Body MRI in 18/74 patients) and clinical follow-up (n=74 patients) for at least 24 months containing al clinical and diagnostic information useful for PET performance assessment and outcome. Progression-free survival (PFS) and overall survival (OS) were assessed by using Kaplan-Meier method. The risk of progression (Hazard Ratio-HR) was computed by Cox regression analysis.

Results: Suspicious of recurrent CM was confirmed in 24/27 patients with a positive 18F-FDG-PET/CT scan. Overall, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 82%, 93%, 88%, 89%, and 89%, with area under the curve being 0.87 (95%IC 0.78-0.97; p<0.05). 18F-FDG-PET/CT findings significantly influenced the therapeutic management in 18 patients (modifying therapy in 10 patients; guiding surgery in 8 patients). After 2 years of follow-up, PFS was significantly longer in patients with a negative vs. a positive 18F-FDG-PET/CT scan (90% vs 46%, p<0.05; Figure 1). Moreover, a negative study was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Figure 2). In addition, a positive 18F-FDG-PET/CT scan was associated with an increased risk of disease progression (HR=8.2; p<0.05).

Conclusion: 18F-FDG-PET/CT showed a valuable diagnostic performance in patients with suspicious of recurrent CM. This imaging modality might have an important prognostic value in predicting the survival outcomes, assessing the risk of disease progression, and guiding treatment decision making.

Keywords:

18F-FDG-PET/CT, PFS, Cox regression, Melanoma , Statistical analysis, Semi-quantitative analyses

Affiliation:

Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Nuclear Medicine Department A.R.N.A.S GARIBALDI – Nesima, Via Palermo 636, Catania, Nuclear Medicine Department A.R.N.A.S GARIBALDI – Nesima, Via Palermo 636, Catania, Nuclear Medicine Unit, Fondazione Istituto G.Giglio , Ct.da Pietra Pollastra-pisciotto, Cefalù, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Nuclear Medicine Department A.R.N.A.S GARIBALDI – Nesima, Via Palermo 636, Catania, University of Palermo, Unit of Oncology, Fondazione Istituto G.Giglio , Ct.da Pietra Pollastra-pisciotto, Cefalù, Unit of Oncology, Fondazione Istituto G.Giglio , Ct.da Pietra Pollastra-pisciotto, Cefalù, Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Nuclear Medicine Unit, Fondazione Istituto G.Giglio , Ct.da Pietra Pollastra-pisciotto, Cefalù



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