Neel Maria Helvind1, Catalina Aurora Aros Mardones2, Lisbet Rosenkrantz Hölmich3, Helle Westergren Hendel4, Pernille Envold Bidstrup5, Jens Ahm Sørensen6, Annette Hougaard Chakera7. 1. Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. Electronic address: neel.maria.helvind@regionh.dk. 2. Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark. Electronic address: Catalina_A.M@hotmail.com. 3. Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. Electronic address: lisbet.rosenkrantz.hoelmich@regionh.dk. 4. Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark. Electronic address: helle.hendel@regionh.dk. 5. Psychological Aspects of Cancer, Danish Cancer Society's Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark. Electronic address: pernille@cancer.dk. 6. Department of Plastic Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark; Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark. Electronic address: jens.sorensen@rsyd.dk. 7. Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. Electronic address: annette.hougaard.chakera@regionh.dk.
Abstract
INTRODUCTION: The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. MATERIALS AND METHODS: Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. RESULTS: In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). CONCLUSION: Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients.
INTRODUCTION: The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. MATERIALS AND METHODS: Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. RESULTS: In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). CONCLUSION: Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients.