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Comparative Study
. 2012 Apr;198(4):902-8.
doi: 10.2214/AJR.11.7280.

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

Yulia Bronstein  1 , Chaan S Ng, Eric Rohren, Merrick I Ross, Jeffrey E Lee, Janice Cormier, Valen E Johnson, Wen-Jen Hwu
Affiliations
Comparative Study

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

Yulia Bronstein et al. AJR Am J Roentgenol. 2012 Apr.

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.

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Figures

Fig 1
Fig 1
63 year old male with melanoma metastasis to the right adrenal, candidate for right adrenalectomy. A. Right adrenal metastasis appears as a solitary lesion on contrast-enhanced CT (arrow) B. Preoperative PET-CT shows right adrenal metastasis (long arrow) and an unexpected gastric metastasis (short arrow). C. Axial fused PET-CT image shows abnormal focal FDG uptake in the stomach (arrow). D. No abnormality is evident in the gastric wall on contrast enhanced CT. E. Gastric metastasis confirmed on endoscopy. The surgical plan changed to adrenalectomy and partial gastrectomy after neoadjuvant chemotherapy.
Fig 2
Fig 2
47 year old male with bulky right axillary metastasis from the right arm primary melanoma (stage IIIC) was a candidate for a wide local excision and right axillary lymph node dissection. A. Contrast enhanced CT shows large metastatic mass in the right axilla (arrow). B. Preoperative PET-CT shows known primary melanoma of the right arm (arrow), known right axillary metastasis (long arrow), and multiple unexpected skeletal metastases (arrowheads). The surgery was cancelled. C. Axial fused PET-CT image shows intense FDG uptake within T2 vertebra (arrow). D. No obvious skeletal abnormality is seen on contrast enhanced CT.
Fig 3
Fig 3
71 year old male with in transit metastasis in the right arm from the right arm primary melanoma (A), candidate for wide local excision. A. Ultrasound of the right arm shows a 1.5cm hypoechoic subcutaneous nodule compatible with melanoma metastasis. B. Preoperative PET-CT shows 3 FDG-avid intramuscular masses in the left leg (short arrows) in addition to known right arm metastasis (long arrow). The surgery was cancelled. C. Ultrasound of the left thigh demonstrates 5.9 cm heterogeneous hypoechoic soft tissue mass proven by subsequent biopsy as melanoma metastasis.
See this image and copyright information in PMC

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