Sonia Mahajan1, Christopher A Barker2, Audrey Mauguen3, Sandra P D'Angelo4, Randy Yeh1, Neeta Pandit-Taskar5. 1. Molecular Imaging & Therapy Service, Medicine, Memorial Sloan Kettering Cancer Center, New York. 2. Department of Radiation Oncology, Medicine, Memorial Sloan Kettering Cancer Center, New York. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York; and. 4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York. 5. Molecular Imaging & Therapy Service, Medicine, Memorial Sloan Kettering Cancer Center, New York; pandit-n@mskcc.org.
Abstract
The purpose of this study was to investigate the diagnostic and prognostic value of 18F-FDG PET/CT for surveillance imaging in patients treated for stage III Merkel cell carcinoma (MCC). Methods: This retrospective study included 61 consecutive stage III MCC patients who were clinically asymptomatic and underwent surveillance 18F-FDG PET/CT. Findings were correlated with either pathology or clinical/imaging follow-up. The median follow-up period was 4.8 y. Statistical analyses were performed. Results: 18F-FDG PET/CT detected unsuspected recurrences in 33% patients (20/61) with lesion-based sensitivity, specificity, and accuracy of 92%, 93%, and 93%, respectively. The mean ± SD SUV for malignant and benign lesions was 7.5 ± 3.9 and 3.8 ± 2.0, respectively. Unknown distant metastases, as first recurrence site, were noted in 12 of 61 patients. Those with positive disease on 18F-FDG PET/CT within 1 y of definitive treatment had relatively worse overall survival (P < 0.0001). After adjustment on stage, risk of death increased with a higher SUVmax (hazard ratio for 1 unit = 1.17; P = 0.006) and with a higher number of positive lesions on 18F-FDG PET/CT (hazard ratio for 1 additional lesion = 1.60; P < 0.001). Conclusion: Postdefinitive treatment surveillance 18F-FDG PET/CT scanning detects unsuspected recurrences and has prognostic value. Inclusion of 18F-FDG PET/CT within the first 6 mo after definitive treatment would be appropriate for surveillance and early detection of recurrence. Our data merit further studies to evaluate the prognostic implications.
The purpose of this study was to investigate the diagnostic and prognostic value of 18F-FDG PET/CT for surveillance imaging in patients treated for stage III Merkel cell carcinoma (MCC). Methods: This retrospective study included 61 consecutive stage III MCC patients who were clinically asymptomatic and underwent surveillance 18F-FDG PET/CT. Findings were correlated with either pathology or clinical/imaging follow-up. The median follow-up period was 4.8 y. Statistical analyses were performed. Results: 18F-FDG PET/CT detected unsuspected recurrences in 33% patients (20/61) with lesion-based sensitivity, specificity, and accuracy of 92%, 93%, and 93%, respectively. The mean ± SD SUV for malignant and benign lesions was 7.5 ± 3.9 and 3.8 ± 2.0, respectively. Unknown distant metastases, as first recurrence site, were noted in 12 of 61 patients. Those with positive disease on 18F-FDG PET/CT within 1 y of definitive treatment had relatively worse overall survival (P < 0.0001). After adjustment on stage, risk of death increased with a higher SUVmax (hazard ratio for 1 unit = 1.17; P = 0.006) and with a higher number of positive lesions on 18F-FDG PET/CT (hazard ratio for 1 additional lesion = 1.60; P < 0.001). Conclusion: Postdefinitive treatment surveillance 18F-FDG PET/CT scanning detects unsuspected recurrences and has prognostic value. Inclusion of 18F-FDG PET/CT within the first 6 mo after definitive treatment would be appropriate for surveillance and early detection of recurrence. Our data merit further studies to evaluate the prognostic implications.
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