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. 2019 Jul 1;7(7):CD012806.
doi: 10.1002/14651858.CD012806.pub2.

Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma

Jacqueline Dinnes  1 , Lavinia Ferrante di Ruffano, Yemisi Takwoingi, Seau Tak Cheung, Paul Nathan, Rubeta N Matin, Naomi Chuchu, Sue Ann Chan, Alana Durack, Susan E Bayliss, Abha Gulati, Lopa Patel, Clare Davenport, Kathie Godfrey, Manil Subesinghe, Zoe Traill, Jonathan J Deeks, Hywel C Williams; Cochrane Skin Cancer Diagnostic Test Accuracy Group
Affiliations

Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma

Jacqueline Dinnes et al. Cochrane Database Syst Rev. .

Abstract

Background: Melanoma is one of the most aggressive forms of skin cancer, with the potential to metastasise to other parts of the body via the lymphatic system and the bloodstream. Melanoma accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Various imaging tests can be used with the aim of detecting metastatic spread of disease following a primary diagnosis of melanoma (primary staging) or on clinical suspicion of disease recurrence (re-staging). Accurate staging is crucial to ensuring that patients are directed to the most appropriate and effective treatment at different points on the clinical pathway. Establishing the comparative accuracy of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT imaging for detection of nodal or distant metastases, or both, is critical to understanding if, how, and where on the pathway these tests might be used.

Objectives: Primary objectivesWe estimated accuracy separately according to the point in the clinical pathway at which imaging tests were used. Our objectives were:• to determine the diagnostic accuracy of ultrasound or PET-CT for detection of nodal metastases before sentinel lymph node biopsy in adults with confirmed cutaneous invasive melanoma; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging in adults with cutaneous invasive melanoma:○ for detection of any metastasis in adults with a primary diagnosis of melanoma (i.e. primary staging at presentation); and○ for detection of any metastasis in adults undergoing staging of recurrence of melanoma (i.e. re-staging prompted by findings on routine follow-up).We undertook separate analyses according to whether accuracy data were reported per patient or per lesion.Secondary objectivesWe sought to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging (detection of any metastasis) in mixed or not clearly described populations of adults with cutaneous invasive melanoma.For study participants undergoing primary staging or re-staging (for possible recurrence), and for mixed or unclear populations, our objectives were:• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of nodal metastases;• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases according to metastatic site.

Search methods: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles.

Selection criteria: We included studies of any design that evaluated ultrasound (with or without the use of fine needle aspiration cytology (FNAC)), CT, MRI, or PET-CT for staging of cutaneous melanoma in adults, compared with a reference standard of histological confirmation or imaging with clinical follow-up of at least three months' duration. We excluded studies reporting multiple applications of the same test in more than 10% of study participants.

Data collection and analysis: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2)). We estimated accuracy using the bivariate hierarchical method to produce summary sensitivities and specificities with 95% confidence and prediction regions. We undertook analysis of studies allowing direct and indirect comparison between tests. We examined heterogeneity between studies by visually inspecting the forest plots of sensitivity and specificity and summary receiver operating characteristic (ROC) plots. Numbers of identified studies were insufficient to allow formal investigation of potential sources of heterogeneity.

Main results: We included a total of 39 publications reporting on 5204 study participants; 34 studies reporting data per patient included 4980 study participants with 1265 cases of metastatic disease, and seven studies reporting data per lesion included 417 study participants with 1846 potentially metastatic lesions, 1061 of which were confirmed metastases. The risk of bias was low or unclear for all domains apart from participant flow. Concerns regarding applicability of the evidence were high or unclear for almost all domains. Participant selection from mixed or not clearly defined populations and poorly described application and interpretation of index tests were particularly problematic.The accuracy of imaging for detection of regional nodal metastases before sentinel lymph node biopsy (SLNB) was evaluated in 18 studies. In 11 studies (2614 participants; 542 cases), the summary sensitivity of ultrasound alone was 35.4% (95% confidence interval (CI) 17.0% to 59.4%) and specificity was 93.9% (95% CI 86.1% to 97.5%). Combining pre-SLNB ultrasound with FNAC revealed summary sensitivity of 18.0% (95% CI 3.58% to 56.5%) and specificity of 99.8% (95% CI 99.1% to 99.9%) (1164 participants; 259 cases). Four studies demonstrated lower sensitivity (10.2%, 95% CI 4.31% to 22.3%) and specificity (96.5%,95% CI 87.1% to 99.1%) for PET-CT before SLNB (170 participants, 49 cases). When these data are translated to a hypothetical cohort of 1000 people eligible for SLNB, 237 of whom have nodal metastases (median prevalence), the combination of ultrasound with FNAC potentially allows 43 people with nodal metastases to be triaged directly to adjuvant therapy rather than having SLNB first, at a cost of two people with false positive results (who are incorrectly managed). Those with a false negative ultrasound will be identified on subsequent SLNB.Limited test accuracy data were available for whole body imaging via PET-CT for primary staging or re-staging for disease recurrence, and none evaluated MRI. Twenty-four studies evaluated whole body imaging. Six of these studies explored primary staging following a confirmed diagnosis of melanoma (492 participants), three evaluated re-staging of disease following some clinical indication of recurrence (589 participants), and 15 included mixed or not clearly described population groups comprising participants at a number of different points on the clinical pathway and at varying stages of disease (1265 participants). Results for whole body imaging could not be translated to a hypothetical cohort of people due to paucity of data.Most of the studies (6/9) of primary disease or re-staging of disease considered PET-CT, two in comparison to CT alone, and three studies examined the use of ultrasound. No eligible evaluations of MRI in these groups were identified. All studies used histological reference standards combined with follow-up, and two included FNAC for some participants. Observed accuracy for detection of any metastases for PET-CT was higher for re-staging of disease (summary sensitivity from two studies: 92.6%, 95% CI 85.3% to 96.4%; specificity: 89.7%, 95% CI 78.8% to 95.3%; 153 participants; 95 cases) compared to primary staging (sensitivities from individual studies ranged from 30% to 47% and specificities from 73% to 88%), and was more sensitive than CT alone in both population groups, but participant numbers were very small.No conclusions can be drawn regarding routine imaging of the brain via MRI or CT.

Authors' conclusions: Review authors found a disappointing lack of evidence on the accuracy of imaging in people with a diagnosis of melanoma at different points on the clinical pathway. Studies were small and often reported data according to the number of lesions rather than the number of study participants. Imaging with ultrasound combined with FNAC before SLNB may identify around one-fifth of those with nodal disease, but confidence intervals are wide and further work is needed to establish cost-effectiveness. Much of the evidence for whole body imaging for primary staging or re-staging of disease is focused on PET-CT, and comparative data with CT or MRI are lacking. Future studies should go beyond diagnostic accuracy and consider the effects of different imaging tests on disease management. The increasing availability of adjuvant therapies for people with melanoma at high risk of disease spread at presentation will have a considerable impact on imaging services, yet evidence for the relative diagnostic accuracy of available tests is limited.

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Conflict of interest statement

Jacqueline Dinnes: I am employed by the University of Birmingham under an NIHR Cochrane Programme Grant (13‐89‐15) to produce the review. Lavinia Ferrante di Ruffano: nothing to declare. Yemisi Takwoingi: nothing to declare. Seau Tak Cheung: nothing to declare. Paul Nathan: I have received consultancy fees from Bristol Myers Squibb (BMS), Pfizer, Merck Sharp Dohme (MSD), Merck, and Immunocore to sit on advisory boards. I have received payment from BMS and Novartis for lectures at satellite symposia; payment from BMS for webcasts; payment of travel, accommodations, and meeting expenses from BMS and MSD for attending conferences of the American Society of Clinical Oncology, the Society for Melanoma Research, and the European Society of Medical Oncology. Rubeta N Matin: my institution received a grant for a Barco NV commercially sponsored study to evaluate digital dermoscopy in the skin cancer clinic. My institution also received Oxfordshire Health Services Research Charitable Funds for carrying out a study of feasibility of using the Skin Cancer Quality of Life Impact Tool (SCQOLIT) in non‐melanoma skin cancer, and ScARF funding for the melanoma unmet needs study. I have received payment from Public Health England for the "Be Clear on Cancer Skin Cancer" report; payment for development of educational presentations on skin toxicity for BMS; and royalties for the Oxford Handbook of Medical Dermatology (Oxford University Press). I have no conflicts of interest to declare that directly relate to the publication of this work. Naomi Chuchu: nothing to declare. Sue Ann Chan: nothing to declare. Alana Durack: nothing to declare. Susan E Bayliss: nothing to declare. Abha Gulati: nothing to declare. Lopa Patel: nothing to declare. Clare Davenport: my employer (University of Birmingham) received funding for my participation in this review as part of an NIHR programme grant awarded to Jac Dinnes, the PI. Kathie Godfrey: nothing to declare. Manil Subsesinghe: nothing to declare. Zoe Traill: nothing to declare. Jonathan J Deeks: my employer (University of Birmingham) received funding for my participation in this review as part of an NIHR programme grant awarded to Jac Dinnes, the PI. Hywel C Williams: I am director of the NIHR HTA Programme. HTA is part of the NIHR, which also supports the NIHR systematic reviews programme from which this work is funded.

Figures

1
1
Sample photographs of superficial spreading melanoma (left) and nodular melanoma (right). Copyright © 2010 Dr. Rubeta Matin: reproduced with permission.
2
2
Summary of 2015 NICE guideline recommendations for the management of cutaneous melanoma following primary diagnosis (NICE 2015a); not necessarily reflective of current practice.
3
3
PRISMA flow diagram.
4
4
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
5
5
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
6
6
Forest plot of all data for pre‐SLNB ultrasound, ultrasound plus FNAC, or PET‐CT for the detection of nodal metastasis.
 (HN MM ‐ head and neck only malignant melanoma.)
7
7
Summary ROC plot comparing pre‐SLNB ultrasound vs ultrasound plus FNAC vs PET‐CT.
8
8
Forest plot of imaging for primary staging, for the detection of any metastases, nodal metastases, and distant metastases (per patient and per lesion data).
9
9
Forest plot of imaging for re‐staging of melanoma, for the detection of any metastases or nodal metastases (per patient and per lesion data).
10
10
Forest plot of tests for the detection of any metastases (mixed populations ‐ per patient data).
11
11
Forest plot of tests for the detection of any metastases (mixed populations ‐ per lesion data).
12
12
ROC plot of direct comparisons between CT and MRI for the detection of any metastases in mixed population group studies (per lesion data).
13
13
ROC plot of direct comparisons between CT and PET‐CT for the detection of any metastases in mixed population group studies (per lesion data).
14
14
ROC plot of direct comparisons between MRI and PET‐CT for the detection of any metastases in mixed population group studies (per lesion data).
15
15
Forest plot of tests for the detection of nodal metastases (mixed populations ‐ per patient data).
16
16
Forest plot of tests for the detection of nodal metastases (mixed populations ‐ per lesion data).
17
17
ROC plot of direct comparisons between CT and MRI for the detection of nodal metastases in mixed population group studies (per lesion data).
18
18
ROC plot of direct comparisons between CT and PET‐CT for the detection of nodal metastases in mixed population group studies (per lesion data).
19
19
ROC plot of direct comparisons between MRI and PET‐CT for the detection of nodal metastases in mixed population group studies (per lesion data).
20
20
Forest plot of tests for the detection of distant metastases (mixed populations ‐ per patient data only).
21
21
Forest plot of tests for the detection of distant metastases (per lesion data).
22
22
ROC plot of direct comparisons between CT and MRI for the detection of distant metastases in mixed population group studies (per lesion data).
23
23
ROC plot of direct comparisons between CT and PET‐CT for the detection of distant metastases in mixed population group studies (per lesion data).
24
24
ROC plot of direct comparisons between MRI and PET‐CT for the detection of distant metastases in mixed population group studies (per lesion data).
25
25
Forest plot of tests for the detection of bone metastasis in mixed population groups (per lesion data).
26
26
Forest plot of tests for the detection of lung metastasis in mixed population groups (per lesion data).
27
27
Forest plot of tests for the detection of liver metastasis in mixed population groups (per lesion data).
28
28
Forest plot of tests: 75 soft tissue metastasis ‐ PET‐CT ‐ MIXED (per lesion), 76 local/subcutaneous metastasis ‐ CT ‐ MIXED (per lesion), 77 local/subcutaneous metastasis ‐ MRI ‐ MIXED (per lesion), 78 local/subcutaneous metastasis ‐ MRI (DW + VIBE) ‐ MIXED (per lesion), 79 local/subcutaneous metastasis ‐ PET‐CT ‐ MIXED (per lesion).
1
1. Test
Pre‐SLNB US vs Histology ‐ Nodal mets ‐ per patient.
2
2. Test
Pre‐SLNB US (stringent US criteria) vs Histology ‐ Nodal mets ‐ per patient.
3
3. Test
Pre‐SLNB US‐FNAC ‐ Nodal mets ‐ per patient.
4
4. Test
Pre‐SLNB PET‐CT vs Histology ‐ Nodal mets ‐ all SLNB ‐ per patient.
5
5. Test
Pre‐SLNB PET‐CT vs Histology ‐ Nodal mets ‐ high risk ‐ per patient.
6
6. Test
Pre‐SLNB PET‐CT vs Histology ‐ Nodal mets ‐ head and neck only ‐ per patient.
7
7. Test
Pre‐SLNB PET‐CT vs Histology/FU ‐ Nodal mets ‐ high risk ‐ per patient.
8
8. Test
Pre‐SLNB PET‐CT vs Histology/FU ‐ Nodal mets ‐ head and neck only ‐ per patient.
9
9. Test
Any metastasis ‐ PET‐CT ‐ PRIMARY ‐ Any stage (per pt).
10
10. Test
Any metastasis ‐ PET‐CT ‐ PRIMARY ‐ BT > 4 mm (per pt).
11
11. Test
Any metastasis ‐ CT ‐ RE‐STAGING ‐ Any stage (per pt).
12
12. Test
Any metastasis ‐ PET‐CT ‐ RE‐STAGING ‐ Any stage (per pt).
13
13. Test
Any metastasis ‐ PET‐CT ‐ RE‐STAGING ‐ Stage IIIb or less (per pt).
14
14. Test
Any metastasis ‐ PET‐CT ‐ RE‐STAGING ‐ Stage IIIc to IV (per pt).
15
15. Test
Any metastasis ‐ CT‐ MIXED ‐ All data (per pt).
16
16. Test
Any metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per pt).
17
17. Test
Any metastasis ‐ PET‐CT (plus CT) ‐ Mixed ‐ Any stage (per pt).
18
18. Test
Any metastasis ‐ PET‐CT ‐ RE‐STAGING ‐ Any stage (per lesion).
19
19. Test
Any metastasis ‐ CT‐ MIXED ‐ All data (per lesion).
20
20. Test
Any metastasis (incl brain) ‐ CT (U) ‐ MIXED (per lesion).
21
21. Test
Any metastasis (incl brain) ‐ CT (CE) ‐ MIXED (per lesion).
22
22. Test
Any metastasis ‐ MRI ‐ MIXED ‐ All data (per lesion).
23
23. Test
Any metastasis (excl brain) ‐ MRI (DW + VIBE) ‐ MIXED (per lesion).
24
24. Test
Any metastasis (incl brain) ‐ MRI (DW) ‐ MIXED (per lesion).
25
25. Test
Any metastasis (incl brain) ‐ MRI (DW + VIBE) ‐ MIXED (per lesion).
26
26. Test
Any metastasis (incl brain) ‐ MRI plus CT ‐ MIXED (per lesion).
27
27. Test
Any metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
28
28. Test
Any metastasis (incl brain) ‐ PET‐CT (U) ‐ MIXED (per lesion).
29
29. Test
Any metastasis (direct test comparisons) ‐ CT ‐ Mixed ‐ Stage III/IV (per lesion).
30
30. Test
Any metastasis (direct test comparisons) ‐ MRI ‐ Mixed ‐ Stage III/IV (per lesion).
31
31. Test
Any metastasis (direct test comparisons) ‐ PET‐CT ‐ Mixed ‐ Stage III/IV (per lesion).
32
32. Test
Nodal metastasis ‐ US ‐ PRIMARY (per pt).
33
33. Test
Nodal metastasis ‐ CT ‐ PRIMARY (per pt).
34
34. Test
Nodal metastasis ‐ PET‐CT ‐ PRIMARY (per pt).
35
35. Test
Nodal metastasis ‐ US ‐ RE‐STAGING (per pt).
36
36. Test
Nodal metastasis ‐ US plus US (CE) ‐ RE‐STAGING (per pt).
37
37. Test
Nodal metastasis ‐ US ‐ MIXED (per pt).
38
38. Test
Nodal metastasis ‐ CT ‐ MIXED (per pt).
39
39. Test
Nodal metastasis (superficial groin) ‐ PET‐CT (indeterminate test positive) ‐ MIXED (per pt).
40
40. Test
Nodal metastasis (superficial groin) ‐ PET‐CT (indeterminate test negative) ‐ MIXED (per pt).
41
41. Test
Nodal metastasis (deep groin) ‐ PET‐CT (indeterminate test positive) ‐ MIXED (per pt).
42
42. Test
Nodal metastasis (deep groin) ‐ PET‐CT (indeterminate test negative) ‐ MIXED (per pt).
43
43. Test
Nodal metastasis ‐ PET‐CT ‐ MIXED (per pt).
44
44. Test
Nodal metastasis ‐ CT ‐ MIXED ‐ All data (per lesion).
45
45. Test
Nodal metastasis ‐ MRI ‐ MIXED ‐ All data (per lesion).
46
46. Test
Nodal metastasis ‐ MRI (DW + VIBE) ‐ MIXED (per lesion).
47
47. Test
Nodal metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
48
48. Test
Superficial nodal metastasis ‐ US ‐ Mixed ‐ stage IV (per LNB).
49
49. Test
Superficial nodal metastasis ‐ CT ‐ Mixed ‐ stage IV (per LNB).
50
50. Test
Superficial nodal metastasis ‐ MRI ‐ Mixed ‐ stage IV (per LNB).
51
51. Test
Superficial nodal metastasis ‐ MRI (DW + VIBE) ‐ Mixed ‐ Stage IV (per lesion).
52
52. Test
Superficial nodal metastasis ‐ PET‐CT ‐ Mixed ‐ stage IV (per LNB).
53
53. Test
Distant metastasis ‐ CT ‐ PRIMARY (per pt).
54
54. Test
Distant metastasis ‐ PET‐CT ‐ PRIMARY (per pt).
55
55. Test
Distant metastasis ‐ CT ‐ MIXED ‐ All data (per pt).
56
56. Test
Distant metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per pt).
57
57. Test
Distant metastasis ‐ CT ‐ Mixed ‐ All data (per lesion).
58
58. Test
Distant metastasis ‐ MRI ‐ Mixed ‐ All data (per lesion).
59
59. Test
Distant metastasis ‐ PET‐CT ‐ Mixed ‐ All data (per lesion).
60
60. Test
Distant metastasis (excl brain) ‐ MRI (DW + VIBE) ‐ Mixed ‐ stage III/IV (per lesion).
61
61. Test
Distant metastasis (incl brain) ‐ MRI (DW) ‐ Mixed ‐ stage III/IV (per lesion).
62
62. Test
Distant metastasis (incl brain) ‐ MRI (DW + VIBE) ‐ Mixed ‐ stage III/IV (per lesion).
63
63. Test
Bone metastasis ‐ CT‐ MIXED ‐ All data (per lesion).
64
64. Test
Bone metastasis ‐ MRI ‐ MIXED ‐ All data (per lesion).
65
65. Test
Bone metastasis ‐ MRI (DW + VIBE) ‐ MIXED ‐ All data (per lesion).
66
66. Test
Bone metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
67
67. Test
Liver metastasis ‐ CT‐ MIXED ‐ All data (per lesion).
68
68. Test
Liver metastasis ‐ MRI ‐ MIXED ‐ All data (per lesion).
69
69. Test
Liver metastasis ‐ MRI (DW + VIBE) ‐ Mixed ‐ stage III/IV (per lesion).
70
70. Test
Liver metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
71
71. Test
Lung metastasis ‐ CT ‐ MIXED ‐ All data (per lesion).
72
72. Test
Lung metastasis ‐ MRI ‐ MIXED ‐ All data (per lesion).
73
73. Test
Lung metastasis ‐ MRI (DW + VIBE) ‐ Mixed ‐ stage III/IV (per lesion).
74
74. Test
Lung metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
75
75. Test
Soft tissue metastasis ‐ PET‐CT ‐ MIXED (per lesion).
76
76. Test
Local/subcutaneous metastasis ‐ CT ‐ MIXED (per lesion).
77
77. Test
Local/subcutaneous metastasis ‐ MRI ‐ MIXED (per lesion).
78
78. Test
Local/subcutaneous metastasis ‐ MRI (DW + VIBE) ‐ MIXED (per lesion).
79
79. Test
Local/subcutaneous metastasis ‐ PET‐CT ‐ MIXED (per lesion).
80
80. Test
Brain metastasis ‐ CT‐ MIXED ‐ All data (per lesion).
81
81. Test
Brain metastasis ‐ MRI (DW) ‐ MIXED ‐ All data (per lesion).
82
82. Test
Brain metastasis ‐ MRI (DW + VIBE) ‐ MIXED ‐ All data (per lesion).
83
83. Test
Brain metastasis ‐ PET‐CT ‐ MIXED ‐ All data (per lesion).
93
93. Test
'Other' metastasis ‐ CT ‐ Mixed ‐ Any stage (per lesion).
94
94. Test
'Other' metastasis ‐ MRI ‐ Mixed ‐ Any stage (per lesion).
95
95. Test
'Other' metastasis ‐ PET‐CT ‐ Mixed ‐ Any stage (per lesion).
96
96. Test
'Other' metastasis ‐ CT ‐ Mixed ‐ stage III/IV (per lesion).
97
97. Test
'Other' metastasis ‐ MRI ‐ Mixed ‐ stage III/IV (per lesion).
98
98. Test
'Other' metastasis ‐ PET‐CT ‐ Mixed ‐ stage III/IV (per lesion).
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References

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Kell 2007 {published data only}
    1. Kell MR, Ridge JA, Joseph N, Sigurdson ER. PET CT imaging in patients undergoing sentinel node biopsy for melanoma. European Journal of Cancer Surgery 2007;33(7):911‐3. [DOI: 10.1016/j.ejso.2006.11.016; PUBMED: 17207956] - DOI - PubMed
Klebl 2003 {published data only}
    1. Klebl FH, Gelbmann CM, Lammert I, Bogenrieder T, Stolz W, Scholmerich J, et al. Detection of lymph node metastases of malignant melanoma by palpation and ultrasound. Medizinische Klinik 2003;98(12):783‐7. [PUBMED: 14685681] - PubMed
Klode 2010 {published data only}
    1. Klode J, Dissemond J, Grabbe S, Hillen U, Poeppel T, Boeing C. Sentinel lymph node excision and PET‐CT in the initial stage of malignant melanoma: a retrospective analysis of 61 patients with malignant melanoma in American Joint Committee on Cancer stages I and II. Dermatologic Surgery 2010;36(4):439‐45. [PUBMED: 20187901] - PubMed
Kunte 2009 {published data only}
    1. Kunte C, Schuh T, Eberle JY, Baumert J, Konz B, Volkenandt M, et al. The use of high‐resolution ultrasonography for preoperative detection of metastases in sentinel lymph nodes of patients with cutaneous melanoma. Dermatologic Surgery 2009;35(11):1757‐65. [PUBMED: 19660025] - PubMed
Maubec 2007 {published data only}
    1. Maubec E, Lumbroso J, Masson F, Suciu V, Kolb F, Mamelle G, et al. F‐18 fluorodeoxy‐D‐glucose positron emission tomography scan in the initial evaluation of patients with a primary melanoma thicker than 4 mm. Melanoma Research 2007;17(3):147‐54. [PUBMED: 17505260] - PubMed
Pfannenberg 2007 {published data only}
    1. Pfannenberg C, Aschoff P, Schanz S, Eschmann SM, Plathow C, Eigentler TK, et al. Prospective comparison of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography and whole‐body magnetic resonance imaging in staging of advanced malignant melanoma. European Journal of Cancer 2007;43(3):557‐64. [PUBMED: 17224266] - PubMed
Pfluger 2011 {published data only}
    1. Pfluger T, Melzer HI, Schneider V, Fougere C, Coppenrath E, Berking C, et al. PET/CT in malignant melanoma: contrast‐enhanced CT versus plain low‐dose CT. European Journal of Nuclear Medicine & Molecular Imaging 2011;38(5):822‐31. [PUBMED: 21210112] - PubMed
Prayer 1990 {published data only}
    1. Prayer L, Winkelbauer H, Gritzmann N, Winkelbauer F, Helmer M, Pehamberger H. Sonography versus palpation in the detection of regional lymph‐node metastases in patients with malignant melanoma. European Journal of Cancer 1990;26(7):827‐30. [PUBMED: 2145905] - PubMed
Radzhabova 2009 {published data only}
    1. Radzhabova ZA, Barchuk AS, Kostromina EV, Anisimov VV. [The detection of early regional metastases in patients with skin melanoma by dopplerography]. Vestnik Khirurgii Imeni I. I. Grekova 2009;168(1):50‐53. [PUBMED: 19432146] - PubMed
Reinhardt 2006 {published data only}
    1. Reinhardt MJ, Joe AY, Jaeger U, Huber A, Matthies A, Bucerius J, et al. Diagnostic performance of whole body dual modality 18F‐FDG PET/CT imaging for N‐ and M‐staging of malignant melanoma: experience with 250 consecutive patients. Journal of Clinical Oncology 2006;24(7):1178‐87. [PUBMED: 16505438] - PubMed
Revel 2010 {published data only}
    1. Revel A, Revel C, Dolivet G, Gillet N, Didot N, Meneroux B, et al. Is 18FDG PET‐CT useful for detecting occult nodal metastases in patients with cutaneous head and neck melanoma, in addition to sentinel lymph node biopsy? [La TEP‐TDM au 18FDG a‐t‐elle un interet dans la stadification ganglionnaire des melanomes malins cutanes cervicofaciaux beneficiant de la technique du ganglion sentinelle? A propos de 22 cas]. Medecine Nucleaire 2010;34(9):528‐39. [DOI: 10.1016/j.mednuc.2010.06.007] - DOI
Rubaltelli 2011 {published data only}
    1. Rubaltelli L, Beltrame V, Tregnaghi A, Scagliori E, Frigo AC, Stramare R. Contrast‐enhanced ultrasound for characterizing lymph nodes with focal cortical thickening in patients with cutaneous melanoma. AJR. American Journal of Roentgenology 2011;196(1):W8‐12. [PUBMED: 21178038] - PubMed
Sanki 2009 {published data only}
    1. Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, et al. Targeted high‐resolution ultrasound is not an effective substitute for sentinel lymph node biopsy in patients with primary cutaneous melanoma. Journal of Clinical Oncology 2009;27(33):5614‐9. [PUBMED: 19786669] - PubMed
Sibon 2007 {published data only}
    1. Sibon C, Chagnon S, Tchakerian A, Bafounta ML, Longvert C, Clerici T, et al. The contribution of high‐resolution ultrasonography in preoperatively detecting sentinel‐node metastases in melanoma patients. Melanoma Research 2007;17(4):233‐7. [PUBMED: 17625453] - PubMed
Singh 2008 {published data only}
    1. Singh B, Ezziddin S, Palmedo H, Reinhardt M, Strunk H, Tuting T, et al. Preoperative 18F‐FDG‐PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma. Melanoma Research 2008;18(5):346‐52. [PUBMED: 18781133] - PubMed
Strobel 2007a {published data only}
    1. Strobel K, Skalsky J, Kalff V, Baumann K, Seifert B, Joller‐Jemelka H, et al. Tumour assessment in advanced melanoma: value of FDG‐PET/CT in patients with elevated serum S‐100B. European Journal of Nuclear Medicine & Molecular Imaging 2007;34(9):1366‐75. [PUBMED: 17390135] - PubMed
Strobel 2007b {published data only}
    1. Strobel K, Dummer R, Husarik DB, Perez Lago M, Hany TF, Steinert HC. High‐risk melanoma: accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology 2007;244(2):566‐74. [PUBMED: 17641374] - PubMed
van den Brekel 1998 {published data only}
    1. Brekel MW, Pameijer FA, Koops W, Hilgers FJ, Kroon BB, Balm AJ. Computed tomography for the detection of neck node metastases in melanoma patients. European Journal of Surgical Oncology 1998;24(1):51‐4. [PUBMED: 9542517] - PubMed
van Rijk 2006 {published data only}
    1. Rijk MC, Teertstra HJ, Peterse JL, Nieweg OE, Olmos RA, Hoefnagel CA, et al. Ultrasonography and fine‐needle aspiration cytology in the preoperative evaluation of melanoma patients eligible for sentinel node biopsy. Annals of Surgical Oncology 2006;13(11):1511‐6. [PUBMED: 17009151] - PubMed
van Wissen 2016 {published data only}
    1. Wissen J, Hiel B, Hage JA, Wiel BA, Wouters MW, Akkooi AC. The diagnostic value of PET/CT imaging in melanoma groin metastases. Annals of Surgical Oncology 2016;23(7):2323‐9. [PUBMED: 26920386] - PubMed
Veit‐Haibach 2009 {published data only}
    1. Veit‐Haibach P, Vogt FM, Jablonka R, Kuehl H, Bockisch A, Beyer T, et al. Diagnostic accuracy of contrast‐enhanced FDG‐PET/CT in primary staging of cutaneous malignant melanoma. European Journal of Nuclear Medicine & Molecular Imaging 2009;36(6):910‐8. [PUBMED: 19156409] - PubMed
Voit 2014 {published data only}
    1. Voit CA, Gooskens SL, Siegel P, Schaefer G, Schoengen A, Rowert J, et al. Ultrasound‐guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients. European Journal of Cancer 2014;50(13):2280‐8. [PUBMED: 24999208] - PubMed
Wagner 2012 {published data only}
    1. Wagner T, Chevreau C, Meyer N, Mourey L, Courbon F, Zerdoud S. Routine FDG PET‐CT in patients with a high‐risk localized melanoma has a high predictive positive value for nodal disease and high negative predictive value for the presence of distant metastases. Journal of the European Academy of Dermatology & Venereology 2012;26(11):1431‐5. [PUBMED: 22017492] - PubMed

References to studies excluded from this review

Abbott 2009 {published data only}
    1. Abbott R, Harries M, Acland KM, O'Doherty M. Positron‐emission tomography with computed tomography (PET/CT) in melanoma follow‐up. British Journal of Dermatology 2009;161(Suppl 1):36.
Abdi 1988 {published data only}
    1. Abdi EA, Terry T. Lymphography and computed tomography in lymph node metastases from malignant melanoma. Acta Radiologica 1988;29(4):391‐4. - PubMed
Abella‐Columna 2002 {published data only}
    1. Abella‐Columna E, Valk PE. Positron emission tomography imaging in melanoma and lymphoma. Seminars in Roentgenology 2002;37(2):129‐39. - PubMed
Acland 2000 {published data only}
    1. Acland KM, O'Doherty MJ, Russell‐Jones R. The value of positron emission tomography scanning in the detection of subclinical metastatic melanoma. Journal of the American Academy of Dermatology 2000;42(4):606‐11. - PubMed
Acland 2001 {published data only}
    1. Acland KM, Healy C, Calonje E, O'Doherty M, Nunan T, Page C, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. Journal of Clinical Oncology 2001;19(10):2674‐8. - PubMed
Agarwal 2008 {published data only}
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Ahmed 2015 {published data only}
    1. Ahmed F, Fohne L, Muzaffar R, Kelly P, Fernandes H, Tu Y, et al. Bone metastasis as detected by FDG PET with negative CT of the PET/CT: Frequency in 2000 scans. Journal of Nuclear Medicine. Conference: Society of Nuclear Medicine and Molecular Imaging Annual Meeting, SNMMI 2015;56(3):550.
Akcali 2007 {published data only}
    1. Akcali C, Zincirkeser S, Erbagcy Z, Akcali A, Halac M, Durak G, et al. Detection of metastases in patients with cutaneous melanoma using FDG‐PET/CT. Journal of International Medical Research 2007;35(4):547‐53. - PubMed
Aldridge 2010 {published data only}
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Aloia 2006 {published data only}
    1. Aloia TA, Gershenwald JE, Andtbacka RH, Johnson MM, Schacherer CW, Ng CS, et al. Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node‐positive melanoma. Journal of Clinical Oncology 2006;24(18):2858‐65. - PubMed
Alvarado 2007 {published data only}
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Angeles 2014 {published data only}
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Ardizzoni 1987 {published data only}
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Arrangoiz 2011 {published data only}
    1. Arrangoiz R, Papavasiliou P, Houssock C, Berger AC, Kairys JC, Mastrangelo MJ, et al. Preoperative F‐18 fluorodeoxy‐D‐glucose‐positron emission tomography is an important tool in the management of patients with thick (T4) melanoma. Annals of Surgical Oncology 2011;18(1 Suppl):S115.
Ashour 2016 {published data only}
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Bafounta 2004 {published data only}
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Baker 2011 {published data only}
    1. Baker JJ, Meyers MO, Yeh JJ, Frank J, Amos KD, Stitzenberg KB, et al. Routine restaging PET/CT and detection of recurrence in sentinel lymph node positive stage III melanoma. Annals of Surgical Oncology 2011;18(1 Suppl):S114.
Baker 2012 {published data only}
    1. Baker JJ, Newman NA, Levine EA, Deal AM, Frank JS, Stewart JH, et al. Utility of routine PET/CT for initial staging of patients with sentinel lymph node positive melanoma. Annals of Surgical Oncology 2012;19(1 Suppl):S127.
Baker 2014 {published data only}
    1. Baker JJ, Meyers MO, Frank J, Amos KD, Stitzenberg KB, Ollila DW. Routine restaging PET/CT and detection of initial recurrence in sentinel lymph node positive stage III melanoma. American Journal of Surgery 2014;207(4):549‐54. - PubMed
Balagula 2012 {published data only}
    1. Balagula Y, Braun RP, Rabinovitz HS, Dusza SW, Scope A, Liebman TN, et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. Journal of the American Academy of Dermatology 2012;67(2):194.e1‐8. - PubMed
Ban 2013 {published data only}
    1. Ban JN, Ramkumar DP, Tariq M, Mustafa S. The role of ultrasound scanning of the neck in pre‐operative staging of cutaneous squamous‐cell carcinoma of the head and neck. International Journal of Oral and Maxillofacial Surgery 2013;42(10):1351.
Barsky 2014 {published data only}
    1. Barsky M, Cherkassky L, Vezeridis M, Miner TJ. The role of preoperative positron emission tomography/computed tomography (PET/CT) in patients with high‐risk melanoma. Journal of Surgical Oncology 2014;109(7):726‐9. - PubMed
Bastiaannet 2006 {published data only}
    1. Bastiaannet E, Hoekstra OS, Oyen WJ, Jager PL, Wobbes T, Hoekstra HJ. Level of fluorodeoxyglucose uptake predicts risk for recurrence in melanoma patients presenting with lymph node metastases. Annals of Surgical Oncology 2006;13(7):919‐26. - PubMed
Bastiaannet 2008 {published data only}
    1. Bastiaannet E, Wobbes T, Hoekstra OS, Brouwers AH, Oyen WJ, Meijer S, et al. Diagnostic performance of FDG‐PET and CT in the upstaging of melanoma patients with lymph node metastases and the clinical consequences. Pigment Cell & Melanoma Research 2008;21(2):332.
Bastiaannet 2008a {published data only}
    1. Bastiaannet E, Wobbes T, Hoekstra OS, Brouwers AH, Jagt EJ, Oyen W, et al. Detection of distant metastases with FDG‐PET and CT in 251 clinically stage III melanoma patients. Annals of Oncology 2008;19(Suppl 8):viii240‐1.
Bastiaannet 2008b {published data only}
    1. Bastiaannet E, Wobbes T, Meijer S, Hoekstra HJ. Change in treatment as result of FDG‐PET and CT in clinically stage III melanoma patients: a prospective study in 221 patients. Journal of Clinical Oncology 2008;26(15 Suppl):9069.
Bastiaannet 2009a {published data only}
    1. Bastiaannet E, Jong JR, Brouwers AH, Suurmeijer AJ, Hoekstra HJ. The prognostic value of FDG‐PET measured by standardized uptake value in patients with melanoma stage III evaluated in a prospective study. Journal of Clinical Oncology 2009;27(15_suppl):e20000.
Bastiaannet 2010 {published data only}
    1. Bastiaannet E, Uyl C, Brouwers AH, Jagt EJ, Hoekstr OS, Thompson JF, et al. Cost‐effectiveness of adding FDG‐PET or CT to the diagnostic work‐up of melanoma patients stage III. Pigment Cell and Melanoma Research 2010;23(6):941.
Bastiaannet 2012 {published data only}
    1. Bastiaannet E, Uyl‐de Groot CA, Brouwers AH, Jagt EJ, Hoekstra OS, Oyen W, et al. Cost‐effectiveness of adding FDG‐PET or CT to the diagnostic work‐up of patients with stage III melanoma. Annals of Surgery 2012;255(4):771‐6. - PubMed
Beasley 2010 {published data only}
    1. Beasley GM, Selim A, McMahon NS, Coleman A, Abernethy AP, Nelson K, et al. Prospective evaluation of PET/CT as a surveillance tool to define response to therapy and identify new recurrent disease in patients with locally advanced melanoma undergoing regional chemotherapy treatment with melphalan. Annals of Surgical Oncology 2010;17(1 Suppl):S115.
Beasley 2012 {published data only}
    1. Beasley GM, Parsons C, Broadwater G, Selim MA, Marzban S, Abernethy AP, et al. A multicenter prospective evaluation of the clinical utility of F‐18 FDG‐PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma. Annals of Surgery 2012;256(2):350‐6. - PMC - PubMed
Beitollahi 2013 {published data only}
    1. Beitollahi H, Jaap K, Hunsinger M, Woll N, Shabahang M, Blansfield J. Advanced imaging for the detection of occult metastatic disease in patients with American joint committee on cancer stage III melanoma. Annals of Surgical Oncology 2013;20(1 Suppl):S96.
Belhocine 2002 {published data only}
    1. Belhocine T, Pierard G, Labrassinne M, Lahaye T, Rigo P. Staging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection. Oncologist 2002;7(4):271‐8. - PubMed
Ben Lakhdar 2011 {published data only}
    1. Ben Lakhdar A, Ilie M, Tomasic G, Chami L, Robert C, Vielh P. Benefits of ultrasound‐guided fine needle aspiration cytology before lymph node biopsy in melanoma patients. Virchows Archiv 2011;459(1 Suppl):S10.
Bernabo 2015 {published data only}
    1. Bernabo JL, Herrera‐Acosta E, Mendiola‐Fernandez M, Lopez‐Navarro N, Herrera‐Ceballos E. Epidemiologic study and survival analysis of head and neck melanoma: a 17‐year study in Malaga, Spain. Journal of the American Academy of Dermatology 2015;72(5 Suppl 1):AB168.
Beyeler 2006 {published data only}
    1. Beyeler M, Waldispuhl S, Strobel K, Joller‐Jemelka HI, Burg G, Dummer R. Detection of melanoma relapse: first comparative analysis on imaging techniques versus S100 protein. Dermatology 2006;213(3):187‐91. - PubMed
Bhatia 2012 {published data only}
    1. Bhatia KS, Yuen EH, Cho CC, Tong CS, Lee YY, Ahuja AT. A pilot study evaluating real‐time shear wave ultrasound elastography of miscellaneous non‐nodal neck masses in a routine head and neck ultrasound clinic. Ultrasound in Medicine & Biology 2012;38(6):933‐42. - PubMed
Bier 2016 {published data only}
    1. Bier G, Hoffmann V, Kloth C, Othman AE, Eigentler T, Garbe C, et al. CT imaging of bone and bone marrow infiltration in malignant melanoma ‐ Challenges and limitations for clinical staging in comparison to 18FDG‐PET/CT. European Journal of Radiology 2016;85(4):732‐8. - PubMed
Biersack 1987 {published data only}
    1. Biersack HJ, Bockisch A, Vogel J. Scintigraphic detection of malignancies with radiolabeled tumor antibodies [Szintigraphischer Malignomnachweis Mit Radioaktiv Markierten Tumorantikorpern. Klinische Ergebnisse Auf Der Basis Immunhistochemischer Untersuchungen]. Deutsche Medizinische Wochenschrift 1987;112(9):341‐4. - PubMed
Bikhchandani 2014 {published data only}
    1. Bikhchandani J, Wood J, Richards AT, Smith RB. No benefit in staging fluorodeoxyglucose‐positron emission tomography in clinically node‐negative head and neck cutaneous melanoma. Head & Neck 2014;36(9):1313‐6. - PubMed
Binder 1997 {published data only}
    1. Binder M, Kittler H, Steiner A, Dorffner R, Wolff K, Pehamberger H. Lymph node sonography versus palpation for detecting recurrent disease in patients with malignant melanoma. European Journal of Cancer 1997;33(11):1805‐8. - PubMed
Binns 2012 {published data only}
    1. Binns D, Hong E, Lau E. Optimal detection of metastatic malignant melanoma with true whole body FDG‐PET/CT. Internal Medicine Journal 2012;42:22.
Blend 1992 {published data only}
    1. Blend MJ, Ronan SG, Salk DJ, Gupta TK. Role of technetium 99m‐labeled monoclonal antibody in the management of melanoma patients. Journal of Clinical Oncology 1992;10(8):1330‐7. - PubMed
Blessing 1995 {published data only}
    1. Blessing C, Feine U, Geiger L, Carl M, Rassner G, Fierlbeck G. Positron emission tomography and ultrasonography. A comparative retrospective study assessing the diagnostic validity in lymph node metastases of malignant melanoma. Archives of Dermatology 1995;131(12):1394‐8. - PubMed
Blum 2000 {published data only}
    1. Blum A, Schlagenhauff B, Stroebel W, Breuninger H, Rassner G, Garbe C. Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow‐up of patients with cutaneous melanoma: results of a prospective study of 1288 patients. Cancer 2000;88(11):2534‐9. - PubMed
Blum 2006 {published data only}
    1. Blum A, Schmid‐Wendtner MH, Mauss‐Kiefer V, Eberle JY, Kuchelmeister C, Dill‐Muller D. Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: results of a prospective multicenter study. Dermatology 2006;212(1):47‐52. - PubMed
Bode 2011 {published data only}
    1. Bode B, Schaefer N. Ultrasound‐guided fine needle aspirations of PET‐CT findings during staging of malignancies. Cytopathology 2011;22:51.
Bohelay 2014 {published data only}
    1. Bohelay G, Battistella M, Pages C, Basset‐Seguin N, Viguier M, Kerob D, et al. Ultrasound‐guided core needle biopsy (US‐CNB) of superficial lymph nodes: an alternative to fine‐needle aspiration cytology (FNAC) for the diagnosis of lymph node metastasis in melanoma. Journal of Clinical Oncology 2014;32(15 Suppl):e20026. [DOI: 10.1200/jco.2014.32.15_suppl.e20026] - DOI - PubMed
Bohuslavizki 2000 {published data only}
    1. Bohuslavizki KH, Klutmann S, Neuber K, Wedler J, Altenhoff J, Kroger S, et al. Correlation of 18F‐FDG‐PET and histopathology in patients with malignant melanoma. Radiology and Oncology 2000;34(1):1‐9.
Boni 1995 {published data only}
    1. Boni R, Boni RA, Steinert H, Burg G, Buck A, Marincek B, et al. Staging of metastatic melanoma by whole‐body positron emission tomography using 2‐fluorine‐18‐fluoro‐2‐deoxy‐D‐glucose. British Journal of Dermatology 1995;132(4):556‐62. - PubMed
Boni 1996 {published data only}
    1. Boni R. Whole‐body positron emission tomography: an accurate staging modality for metastatic melanoma. Archives of Dermatology 1996;132(7):833‐4. - PubMed
Boni 1996a {published data only}
    1. Boni R, Huch‐Boni RA, Steinert H, Schulthess GK, Burg G. Early detection of melanoma metastasis using fludeoxyglucose F 18 positron emission tomography. Archives of Dermatology 1996;132(8):875‐6. - PubMed
Borrego 2006 {published data only}
    1. Borrego Dorado I, Vazquez Albertino R, Lopez Martin J, Alvarez Perez RM. Evaluation of efficacy and clinical impact of FDG‐PET on patients with suspicion of recurrent cutaneous melanoma. Revista Espanola de Medicina Nuclear 2006;25(5):301‐11. - PubMed
Boy 2011 {published data only}
    1. Boy C, Poeppel TD, Stoffels I, Kuhn J, Dissemond J, Rosenbaum‐Krumme S, et al. Preoperative SPECT/CT in detection of sentinel lymph nodes in melanoma: an analysis of 406 patients. European Journal of Nuclear Medicine and Molecular Imaging 2011;38(Suppl 2):S168.
Brady 2006 {published data only}
    1. Brady MS, Akhurst T, Spanknebel K, Hilton S, Gonen M, Patel A, et al. Utility of preoperative [(18)]f fluorodeoxyglucose‐positron emission tomography scanning in high‐risk melanoma patients. Annals of Surgical Oncology 2006;13(4):525‐32. - PubMed
Breitenbauch 2015 {published data only}
    1. Breitenbauch MT, Holm J, Rodgaard JC, Stolle LB. Utility of chest X‐ray and abdominal ultrasound for stage III cutaneous malignant melanoma. European Journal of Plastic Surgery 2015;38(3):189‐92.
Brenner 1999 {published data only}
    1. Brenner W, Klomp HJ, Bohuslavizki KH, Szonn B, Kampen WU, Henze E. Limited sensitivity of iodine‐123‐2‐hydroxy‐3‐iodo‐6‐methoxy‐N‐[(1‐ethyl‐2‐pyrrolidinyl)methyl ] benzamide whole‐body scintigraphy in patients with malignant melanoma: a comparison with thallium‐201 imaging. European Journal of Nuclear Medicine 1999;26(12):1567‐71. - PubMed
Bronstein 2012 {published data only}
    1. Bronstein Y, Ng CS, Rohren E, Ross MI, Lee JE, Cormier J, et al. 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. American Journal of Roentgenology 2012;198(4):902‐8. - PMC - PubMed
Brountzos 2003 {published data only}
    1. Brountzos EN, Panagiotou IE, Bafaloukos DI, Kelekis DA. Ultrasonographic detection of regional lymph node metastases in patients with intermediate or thick malignant melanoma. Oncology Reports 2003;10(2):505‐10. - PubMed
Buckle 2016 {published data only}
    1. Buckle T, KleinJan GH, Engelen T, Berg NS, DeRuiter MC, Heide U, et al. Diffusion‐weighted‐preparation (D‐prep) MRI as a future extension of SPECT/CT based surgical planning for sentinel node procedures in the head and neck area?. Oral Oncology 2016;60:48‐54. - PubMed
Bude 2004 {published data only}
    1. Bude RO. Does contrast‐enhanced US have potential for sentinel lymph node detection?. Radiology 2004;230(3):603‐4. - PubMed
Buerke 2011 {published data only}
    1. Buerke B, Gerss J, Puesken M, Weckesser M, Heindel W, Wessling J. Usefulness of semi‐automatic volumetry compared to established linear measurements in predicting lymph node metastases in MSCT. Acta Radiologica 2011;52(5):540‐6. - PubMed
Buzaid 1993 {published data only}
    1. Buzaid AC, Sandler AB, Mani S, Curtis AM, Poo WJ, Bolognia JL, et al. Role of computed tomography in the staging of primary melanoma. Journal of Clinical Oncology 1993;11(4):638‐43. - PubMed
Buzaid 1995 {published data only}
    1. Buzaid AC, Tinoco L, Ross MI, Legha SS, Benjamin RS. Role of computed tomography in the staging of patients with local‐regional metastases of melanoma. Journal of Clinical Oncology 1995;13(8):2104‐8. - PubMed
Bydder 1981 {published data only}
    1. Bydder GM, Kreel L. Body computed tomography in the diagnosis of malignant melanoma metastases. Journal of Computed Tomography 1981;5(1):21‐4. - PubMed
Cachin 2012 {published data only}
    1. Cachin F, Gillet B, Isnardi V, Labeille B, Payoux P, Meyer N, et al. Phase III clinical trial comparing the value of 18FDG TEP/CT and 123I‐BZA2 as a melanin tracer for diagnosis of melanoma metastases: results and perspectives. European Journal of Nuclear Medicine and Molecular Imaging 2012;39(Suppl 2):S190.
Catalano 2010 {published data only}
    1. Catalano O, Caraco C, Mozzillo N, Siani A. Locoregional spread of cutaneous melanoma: sonography findings. AJR. American Journal of Roentgenology 2010;194(3):735‐45. - PubMed
Catalano 2010a {published data only}
    1. Catalano O, Setola SV, Vallone P, Raso MM, D'Errico AG. Sonography for locoregional staging and follow‐up of cutaneous melanoma: how we do it. Journal of Ultrasound in Medicine 2010;29(5):791‐802. - PubMed
Catalano 2010b {published data only}
    1. Catalano O, Siani A. Cutaneous melanoma: role of ultrasound in the assessment of locoregional spread. Current Problems in Diagnostic Radiology 2010;39(1):30‐6. - PubMed
Catalano 2011 {published data only}
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Catalano 2015 {published data only}
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Voit 1999 {published data only}
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Voit 2006 {published data only}
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Voit 2009a {published data only}
    1. Voit CA, Akkooi AC, Schafer‐Hesterberg G, Schoengen A, Schmitz PI, Sterry W, et al. Rotterdam Criteria for sentinel node (SN) tumor burden and the accuracy of ultrasound (US)‐guided fine‐needle aspiration cytology (FNAC): can US‐guided FNAC replace SN staging in patients with melanoma?. Journal of Clinical Oncology 2009;27(30):4994‐5000. - PubMed
Voit 2009b {published data only}
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Voit 2009c {published data only}
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Voit 2010a {published data only}
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Voit 2010b {published data only}
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Voit 2011a {published data only}
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Voit 2011b {published data only}
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Voit 2013 {published data only}
    1. Voit CA, Akkooi AC, Siegel P, Schoengen A, Sterry W, Eggermont AM. High sensitivity rate of ultrasound (US) guided fine needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases significantly reduces need for surgical sentinel node (SN) staging in melanoma. Skin Research and Technology 2013;19(1):e574‐5.
Voit 2016 {published data only}
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Wagner 2001 {published data only}
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Wagner 2009a {published data only}
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Wagner 2009b {published data only}
    1. Wagner TL, Julian A, Zerdoud S, Payoux P, Courbon F. Effectiveness of FDG PET for the detection of distant metastases at initial staging of melanoma patients with a positive sentinel lymph node biopsy. European Journal of Nuclear Medicine and Molecular Imaging 2009;36(2 Suppl):S177.
Wagner 2011 {published data only}
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Winkler 2013 {published data only}
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Zukauskaite 2013 {published data only}
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