Daniel Cheng1, Christopher F McNicoll2, Daniel Kirgan3, Maris S Jones4, Mariangela R Rivera5, Gabriela M Doyle6, Margret D De Guzman7, Jennifer Baynosa8, Charles R St Hill9. 1. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: daniel.cheng@unlv.edu. 2. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: christopher.mcnicoll@unlv.edu. 3. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: daniel.kirgan@unlv.edu. 4. Kaiser Permanente, Santa Clara, Homestead, USA. Electronic address: msjones28@gmail.com. 5. South Carolina ENT, Allergy and Sleep Medicine, USA. Electronic address: mariangela.rivera@gmail.com. 6. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: gabriela.doyle@unlv.edu. 7. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: margret.dg@gmail.com. 8. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: jennifer.baynosa@unlv.edu. 9. University of Nevada, Las Vegas, School of Medicine, USA. Electronic address: charles.sthill@unlv.edu.
Abstract
INTRODUCTION: Positron emission tomography computed tomography (PET-CT) is often used to stage nodal metastases in thin cutaneous melanoma, with limited evidence. METHODS: A retrospective review of patients with cutaneous malignant melanoma treated at our institution was performed from 2005 to 2015, identifying those who received a PET-CT prior to lymphadenectomy. Biopsy features, lymph node status, and PET-CT results were collected. We calculated the overall sensitivity, specificity, accuracy, likelihood ratios, and positive predictive value of PET-CT in identifying nodal metastases. Results were stratified by initial biopsy tumor depth. RESULTS: We identified 367 cases; 95 obtained a PET-CT prior to lymphadenectomy. Overall, sensitivity and specificity of PET-CT was 34.6% and 95.4%, respectively. The positive likelihood ratio and negative likelihood ratio were 7.62 and 0.68, respectively. The accuracy was 78.2%. The positive predictive value for T3 and T4 melanomas were 100% and 81.4%, respectively. For thin melanomas, specificity and accuracy was 88.2% and 88.2%, respectively. CONCLUSIONS: PET-CT has low specificity and its use alone is not recommended for initial staging of nodal metastases in thin cutaneous malignant melanoma.
INTRODUCTION: Positron emission tomography computed tomography (PET-CT) is often used to stage nodal metastases in thin cutaneous melanoma, with limited evidence. METHODS: A retrospective review of patients with cutaneous malignant melanoma treated at our institution was performed from 2005 to 2015, identifying those who received a PET-CT prior to lymphadenectomy. Biopsy features, lymph node status, and PET-CT results were collected. We calculated the overall sensitivity, specificity, accuracy, likelihood ratios, and positive predictive value of PET-CT in identifying nodal metastases. Results were stratified by initial biopsy tumor depth. RESULTS: We identified 367 cases; 95 obtained a PET-CT prior to lymphadenectomy. Overall, sensitivity and specificity of PET-CT was 34.6% and 95.4%, respectively. The positive likelihood ratio and negative likelihood ratio were 7.62 and 0.68, respectively. The accuracy was 78.2%. The positive predictive value for T3 and T4 melanomas were 100% and 81.4%, respectively. For thin melanomas, specificity and accuracy was 88.2% and 88.2%, respectively. CONCLUSIONS: PET-CT has low specificity and its use alone is not recommended for initial staging of nodal metastases in thin cutaneous malignant melanoma.
Authors: Ken Kudura; Florentia Dimitriou; Daniela Mihic-Probst; Urs J Muehlematter; Tim Kutzker; Lucas Basler; Robert Förster; Reinhard Dummer; Joanna Mangana; Lars Husmann; Irene A Burger; Michael Christoph Kreissl Journal: Diagnostics (Basel) Date: 2021-05-15