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Current Radiopharmaceuticals

Author(s): Domenico Albano, Demetrio Familiari, Maria C. Fornito, Salvatore Scalisi, Riccardo Laudicella, Massimo Galia, Emanuele Grassedonio, Antonella Ruggeri, Gloria Ganduscio, Marco Messina, Massimiliano Spada, Massimo Midiri and Pierpaolo Alongi*

DOI: 10.2174/1874471012666191009161826

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

Page: [42 - 47] Pages: 6

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Abstract

Background: Several studies on 18F-FDG-PET/CT have investigated the prognostic role of this imaging modality in different tumors after treatment. Nevertheless, its role in restaging patients with recurrent CM still needs to be defined.

Objective: The aim of this retrospective multicenter study was to evaluate the clinical and prognostic impact of 18F-FDG-PET/CT on 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 suspected 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 of 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 all the clinical and diagnostic information useful for the PET performance assessment and outcome. Progression-free survival (PFS) and overall survival (OS) were assessed by using the Kaplan- Meier method. The risk of progression (Hazard Ratio-HR) was computed by the Cox regression analysis.

Results: Suspicion 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%, respectively, 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; Fig. 1). Moreover, a negative scan was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Fig. 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 suspicion 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, melanoma, prognosis, survival, PPV and NPV.

Graphical Abstract

[1]
Nikolaou, V.; Stratigos, A.J. Emerging trends in the epidemiology of melanoma. Br. J. Dermatol., 2014, 170(1), 11-19.
[http://dx.doi.org/10.1111/bjd.12492] [PMID: 23815297]
[2]
Siegel, R.L.; Miller, K.D.; Jemal, A. Cancer statistics, 2016. CA Cancer J. Clin., 2016, 66(1), 7-30.
[http://dx.doi.org/10.3322/caac.21332] [PMID: 26742998]
[3]
Soong, S.J.; Harrison, R.A.; McCarthy, W.H.; Urist, M.M.; Balch, C.M. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J. Surg. Oncol., 1998, 67(4), 228-233.
[http://dx.doi.org/10.1002/(SICI)1096-9098(199804)67:4<228:AID-JSO4>3.0.CO;2-A] [PMID: 9579369]
[4]
Tas, F.; Erturk, K. Recurrence behavior in early-stage cutaneous melanoma: pattern, timing, survival, and influencing factors. Melanoma Res., 2017, 27(2), 134-139.
[http://dx.doi.org/10.1097/CMR.0000000000000332] [PMID: 28099368]
[5]
Trotter, S.C.; Sroa, N.; Winkelmann, R.R.; Olencki, T.; Bechtel, M. A Global Review of Melanoma Follow-up Guidelines. J. Clin. Aesthet. Dermatol., 2013, 6(9), 18-26.
[PMID: 24062870]
[6]
Galia, M.; Albano, D.; Tarella, C.; Patti, C.; Sconfienza, L.M.; Mulè, A.; Alongi, P.; Midiri, M.; Lagalla, R. Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now. Eur. Radiol., 2018, 28(3), 1187-1193.
[http://dx.doi.org/10.1007/s00330-017-5071-x] [PMID: 29018927]
[7]
Lee, H.H.; Paeng, J.C.; Cheon, G.J.; Lee, D.S.; Chung, J.K.; Kang, K.W. Recurrence of Melanoma After Initial Treatment: Diagnostic Performance of FDG PET in Posttreatment Surveillance. Nucl. Med. Mol. Imaging, 2018, 52(5), 327-333.
[http://dx.doi.org/10.1007/s13139-018-0537-6] [PMID: 30344780]
[8]
Baker, J.J.; Meyers, M.O.; Frank, J.; Amos, K.D.; Stitzenberg, K.B.; Ollila, D.W. Routine restaging PET/CT and detection of initial recurrence in sentinel lymph node positive stage III melanoma. Am. J. Surg., 2014, 207(4), 549-554.
[http://dx.doi.org/10.1016/j.amjsurg.2013.04.012] [PMID: 24674829]
[9]
Alongi, P.; Caobelli, F.; Gentile, R.; Stefano, A.; Russo, G.; Albano, D.; Baldari, S.; Gilardi, M.C.; Midiri, M. Recurrent bladder carcinoma: clinical and prognostic role of 18 F-FDG PET/CT. Eur. J. Nucl. Med. Mol. Imaging, 2017, 44(2), 224-233.
[http://dx.doi.org/10.1007/s00259-016-3500-8] [PMID: 27565154]
[10]
Albano, D.; Familiari, D.; Gentile, R.; Scalisi, S.; Midiri, F.; Messina, M.; Spada, M.; Fornito, M.C.; Galia, M.; Midiri, M.; Alongi, P. Clinical and prognostic value of 18F-FDG-PET/CT in restaging of pancreatic cancer. Nucl. Med. Commun., 2018, 39(8), 741-746.
[http://dx.doi.org/10.1097/MNM.0000000000000862] [PMID: 29782393]
[11]
Eiber, M.; Rauscher, I.; Souvatzoglou, M.; Maurer, T.; Schwaiger, M.; Holzapfel, K.; Beer, A.J. Prospective head-to-head comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for restaging of biochemical recurrent prostate cancer. Eur. J. Nucl. Med. Mol. Imaging, 2017, 44(13), 2179-2188.
[http://dx.doi.org/10.1007/s00259-017-3797-y] [PMID: 28803358]
[12]
Alongi, P.; Evangelista, L.; Caobelli, F.; Spallino, M.; Gianolli, L.; Midiri, M.; Picchio, M. Diagnostic and prognostic value of 18F-FDG PET/CT in recurrent germinal tumor carcinoma. Eur. J. Nucl. Med. Mol. Imaging, 2018, 45(1), 85-94.
[http://dx.doi.org/10.1007/s00259-017-3811-4] [PMID: 28828589]
[13]
Fiasconaro, E.; Caobelli, F.; Quartuccio, N. PET/CT for the diagnostic assessment of patients with renal cancer. Clin. Transl. Imaging,, 2018, •••
[http://dx.doi.org/10.1007/s40336-018-0278-7]
[14]
Albano, D.; Caobelli, F.; Quartuccio, N. PET/CT for the diagnostic assessment of patients with testicular cancer. Clin. Transl. Imaging,, 2018, •••
[http://dx.doi.org/10.1007/s40336-018-0277-8]
[15]
Boellaard, R.; O’Doherty, M.J.; Weber, W.A.; Mottaghy, F.M.; Lonsdale, M.N.; Stroobants, S.G.; Oyen, W.J.; Kotzerke, J.; Hoekstra, O.S.; Pruim, J.; Marsden, P.K.; Tatsch, K.; Hoekstra, C.J.; Visser, E.P.; Arends, B.; Verzijlbergen, F.J.; Zijlstra, J.M.; Comans, E.F.; Lammertsma, A.A.; Paans, A.M.; Willemsen, A.T.; Beyer, T.; Bockisch, A.; Schaefer-Prokop, C.; Delbeke, D.; Baum, R.P.; Chiti, A.; Krause, B.J. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur. J. Nucl. Med. Mol. Imaging, 2010, 37(1), 181-200.
[http://dx.doi.org/10.1007/s00259-009-1297-4] [PMID: 19915839]
[16]
Beasley, G.M.; Parsons, C.; Broadwater, G.; Selim, M.A.; Marzban, S.; Abernethy, A.P.; Salama, A.K.; Eikman, E.A.; Wong, T.; Zager, J.S.; Tyler, D.S. A multicenter prospective evaluation of the clinical utility of F-18 FDG-PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma. Ann. Surg., 2012, 256(2), 350-356.
[http://dx.doi.org/10.1097/SLA.0b013e318256d1f5] [PMID: 22691370]
[17]
Mena, E.; Taghipour, M.; Sheikhbahaei, S.; Mirpour, S.; Xiao, J.; Subramaniam, R.M. 18F-FDG PET/CT and melanoma: value of fourth and subsequent posttherapy follow-up scans for patient management. Clin. Nucl. Med., 2016, 41(9), e403-e409.
[http://dx.doi.org/10.1097/RLU.0000000000001275] [PMID: 27355846]
[18]
Lewin, J; Sayers, L; Kee, D; Walpole, I; Sanelli, A Marvelde, LT Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. Ann Oncol.,, 2018, 1;29(7), 1569-1574.
[19]
Vensby, P.H.; Schmidt, G.; Kjær, A.; Fischer, B.M. The value of FDG PET/CT for follow-up of patients with melanoma: a retrospective analysis. Am. J. Nucl. Med. Mol. Imaging, 2017, 7(6), 255-262.
[PMID: 29348980]
[20]
Perissinotti, A.; Rietbergen, DD.; Vidal-Sicart, S.; Riera, AA. Olmos, RAV Melanoma & nuclear medicine: new insights & advances. Melanoma Manag., 2018, 5(1), MMT06.
[http://dx.doi.org/10.2217/mmt-2017-0022]
[21]
Taghipour, M.; Marcus, C.; Sheikhbahaei, S.; Mena, E.; Prasad, S.; Jha, A.K.; Solnes, L.; Subramaniam, R.M. Clinical indications and impact on management: fourth and subsequent posttherapy follow-up 18F-FDG PET/CT scans in oncology patients. J. Nucl. Med., 2017, 58(5), 737-743.
[http://dx.doi.org/10.2967/jnumed.116.183111] [PMID: 27811123]
[22]
Fuster, D.; Chiang, S.; Johnson, G.; Schuchter, L.M.; Zhuang, H.; Alavi, A. Is 18F-FDG PET more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma? J. Nucl. Med., 2004, 45(8), 1323-1327.
[PMID: 15299056]
[23]
Aukema, T.S.; Olmos, R.A.V.; Korse, C.M.; Kroon, B.B.; Wouters, M.W.; Vogel, W.V.; Bonfrer, J.M.; Nieweg, O.E. Utility of FDG PET/CT and brain MRI in melanoma patients with increased serum S-100B level during follow-up. Ann. Surg. Oncol., 2010, 17(6), 1657-1661.
[http://dx.doi.org/10.1245/s10434-010-0963-x] [PMID: 20151211]
[24]
Wieder, H.A.; Tekin, G.; Rosenbaum-Krumme, S.; Klode, J.; Altenbernd, J.; Bockisch, A.; Nagarajah, J. 18FDG-PET to assess recurrence and long term survival in patients with malignant melanoma. Nucl. Med. (Stuttg.), 2013, 52(5), 198-203.
[http://dx.doi.org/10.3413/Nukmed-0584-13-05] [PMID: 23969722]
[25]
Reinhardt, M.J.; Joe, A.Y.; Jaeger, U.; Huber, A.; Matthies, A.; Bucerius, J.; Roedel, R.; Strunk, H.; Bieber, T.; Biersack, H.J.; Tüting, T. 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. J. Clin. Oncol., 2006, 24(7), 1178-1187.
[http://dx.doi.org/10.1200/JCO.2005.03.5634] [PMID: 16505438]
[26]
Jouvet, J.C.; Thomas, L.; Thomson, V.; Yanes, M.; Journe, C.; Morelec, I.; Bracoud, L.; Durupt, F.; Giammarile, F.; Berthezene, Y. Whole-body MRI with diffusion-weighted sequences compared with 18 FDG PET-CT, CT and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma: a prospective study. J. Eur. Acad. Dermatol. Venereol., 2014, 28(2), 176-185.
[http://dx.doi.org/10.1111/jdv.12078] [PMID: 23331931]
[27]
Laurent, V.; Trausch, G.; Bruot, O.; Olivier, P.; Felblinger, J.; Régent, D. Comparative study of two whole-body imaging techniques in the case of melanoma metastases: advantages of multi-contrast MRI examination including a diffusion-weighted sequence in comparison with PET-CT. Eur. J. Radiol., 2010, 75(3), 376-383.
[http://dx.doi.org/10.1016/j.ejrad.2009.04.059] [PMID: 19497694]
[28]
Albano, D.; Patti, C.; Lagalla, R.; Midiri, M.; Galia, M. Whole-body MRI, FDG-PET/CT, and bone marrow biopsy, for the assessment of bone marrow involvement in patients with newly diagnosed lymphoma. J. Magn. Reson. Imaging, 2017, 45(4), 1082-1089.
[http://dx.doi.org/10.1002/jmri.25439] [PMID: 27603267]
[29]
Albano, D.; Patti, C.; Matranga, D.; Lagalla, R.; Midiri, M.; Galia, M. Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin Lymphoma: Predictive role before treatment and early assessment after two courses of ABVD. Eur. J. Radiol., 2018, 103, 90-98.
[http://dx.doi.org/10.1016/j.ejrad.2018.04.014] [PMID: 29803392]