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Lee ST, Kovaleva N, Senko C, Kee D, Scott AM. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Melanoma and Skin Malignancies. PET Clin 2024; 19:231-248. [PMID: 38233284 DOI: 10.1016/j.cpet.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Skin cancers are the most common cancers, with melanoma resulting in the highest cause of death in this category. Accurate clinical, histologic, and imaging staging with fludeoxyglucose positron emission tomography (FDG PET) is most important to guide patient management. Whilst surgical excision with clear margins is the gold-standard treatment for primary cutaneous melanoma, targeted therapies have generated remarkable and rapid clinical responses in melanoma, for which FDG PET also plays an important role in assessment of treatment response and post-therapy surveillance. Non-FDG PET tracers, advanced PET technology, and PET radiomics may potentially change the landscape of the utilization of PET in the imaging of patients with cutaneous malignancies.
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Affiliation(s)
- Sze-Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Natalia Kovaleva
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia
| | - Clare Senko
- Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Australia
| | - Damien Kee
- Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Australia; Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia.
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Zamani-Siahkali N, Mirshahvalad SA, Pirich C, Beheshti M. Diagnostic Performance of [ 18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients. Cancers (Basel) 2024; 16:215. [PMID: 38201642 PMCID: PMC10778455 DOI: 10.3390/cancers16010215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran 1461884513, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
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Mayer KE, Gaa J, Wasserer S, Biedermann T, Persa OD. Whole-Body Imaging for the Primary Staging of Melanomas-A Single-Center Retrospective Study. Cancers (Basel) 2023; 15:5265. [PMID: 37958438 PMCID: PMC10648596 DOI: 10.3390/cancers15215265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Melanoma staging at diagnosis predominantly depends on the tumor thickness. Sentinel lymph node biopsy (SLNB) is a common tool for primary staging. However, for tumors of >4 mm with ulceration, 3D whole-body imaging and, in particular, Fluor-18-Deoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT), is recommended beforehand. This study aimed to investigate the real-world data of whole-body imaging for initial melanoma staging and its impact on the subsequent diagnostic and therapeutic procedures. METHODS In this retrospective single-center study, 94 patients receiving 18F-FDG-PET/CT and six patients with whole-body computed tomography (CT) scans were included. The clinical characteristics, imaging results, and histologic parameters of the primary tumors and metastases were analyzed. RESULTS Besides the patients with primary tumors characterized as pT4b (63%), the patients with pT4a tumors and pT3 tumors close to 4 mm in tumor thickness also received initial whole-body imaging. In 42.6% of the patients undergoing 18F-FDG-PET/CT, the imaging results led to a change in the diagnostic or therapeutic procedure following on from this. In 29% of cases, sentinel lymph node biopsy was no longer necessary. The sensitivity and specificity of 18F-FDG-PET/CT were 66.0% and 93.0%, respectively. CONCLUSION Whole-body imaging as a primary diagnostic tool is highly valuable and influences the subsequent diagnostic and therapeutic procedures in a considerable number of patients with a relatively high tumor thickness. It can help avoid the costs and invasiveness of redundant SLNB and simultaneously hasten the staging of patients at the time of diagnosis.
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Affiliation(s)
- Kristine E. Mayer
- Clinic and Policlinic for Dermatology and Allergology, Technical University Munich, 80802 Munich, Germany
| | - Jochen Gaa
- Institute for Diagnostic and Interventional Radiology, Technical University Munich, 81675 Munich, Germany
| | - Sophia Wasserer
- Clinic and Policlinic for Dermatology and Allergology, Technical University Munich, 80802 Munich, Germany
| | - Tilo Biedermann
- Clinic and Policlinic for Dermatology and Allergology, Technical University Munich, 80802 Munich, Germany
| | - Oana-Diana Persa
- Clinic and Policlinic for Dermatology and Allergology, Technical University Munich, 80802 Munich, Germany
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Mangas Losada M, Romero Robles L, Mendoza Melero A, García Megías I, Villanueva Torres A, Garrastachu Zumarán P, Boulvard Chollet X, Lopci E, Ramírez Lasanta R, Delgado Bolton RC. [ 18F]FDG PET/CT in the Evaluation of Melanoma Patients Treated with Immunotherapy. Diagnostics (Basel) 2023; 13:978. [PMID: 36900122 PMCID: PMC10000458 DOI: 10.3390/diagnostics13050978] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Immunotherapy is based on manipulation of the immune system in order to act against tumour cells, with growing evidence especially in melanoma patients. The challenges faced by this new therapeutic tool are (i) finding valid evaluation criteria for response assessment; (ii) knowing and distinguishing between "atypical" response patterns; (iii) using PET biomarkers as predictive and response evaluation parameters and (iv) diagnosis and management of immunorelated adverse effects. This review is focused on melanoma patients analysing (a) the role of [18F]FDG PET/CT in the mentioned challenges; (b) the evidence of its efficacy. For this purpose, we performed a review of the literature, including original and review articles. In summary, although there are no clearly established or globally accepted criteria, modified response criteria are potentially appropriate for evaluation of immunotherapy benefit. In this context, [18F]FDG PET/CT biomarkers appear to be promising parameters in prediction and assessment of response to immunotherapy. Moreover, immunorelated adverse effects are recognized as predictors of early response to immunotherapy and may be associated with better prognosis and clinical benefit.
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Affiliation(s)
- María Mangas Losada
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Leonardo Romero Robles
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Alejandro Mendoza Melero
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Irene García Megías
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Amós Villanueva Torres
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Puy Garrastachu Zumarán
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Xavier Boulvard Chollet
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Egesta Lopci
- Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Rafael Ramírez Lasanta
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
| | - Roberto C. Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
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Iravani A, Wallace R, Lo SN, Galligan A, Weppler AM, Hicks RJ, Sandhu S. FDG PET/CT Prognostic Markers in Patients with Advanced Melanoma Treated with Ipilimumab and Nivolumab. Radiology 2023; 307:e221180. [PMID: 36853183 DOI: 10.1148/radiol.221180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Despite improved response to combined ipilimumab and nivolumab (hereafter, IpiNivo) treatment for advanced melanoma, many patients exhibit primary or acquired resistance. This, combined with high risk of immune-related adverse events, makes identifying markers predictive of outcomes desirable. Purpose To investigate the prognostic value of fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT parameters at baseline and as part of response monitoring in patients with advanced melanoma undergoing IpiNivo treatment. Materials and Methods This was a single-center retrospective study of adult patients with melanoma who received IpiNivo. Baseline FDG PET/CT parameters that included metabolic tumor volume (MTV), tumor stage, mutation status, Eastern Cooperative Oncology Group performance score, lactate dehydrogenase level, and treatment line were correlated with overall survival in univariable and multivariable Cox regression analyses. Treatment response as determined with FDG PET/CT was correlated with overall survival. Results In total, 122 patients (median age, 61 years [IQR, 51-69 years]; 89 men) were included; 78% (95 of 122) had an Eastern Cooperative Oncology Group score of 0, 52% (45 of 86) had an elevated lactate dehydrogenase level, 39% (48 of 122) had a metastatic stage of M1c and 45% (55 of 122) M1d, 45% (55 of 122) had BRAF V600E/K mutation, and the median MTV was 42 mL. Patients with a higher than median MTV at baseline FDG PET/CT had a lower 12-month survival rate compared with those with a lower than median MTV (43% [95% CI: 32, 58] vs 66% [95% CI: 55, 79], P < .001). In multivariable analysis, higher versus lower than median MTV, Eastern Cooperative Oncology Group performance scores of 1-2 versus 0, and subsequent versus first-line IpiNivo treatment were independently associated with overall survival (hazard ratio [HR]: 1.68 [95% CI: 1.02, 2.78], P = .04; 3.1 [95% CI: 1.8, 5.4], P < .001; and 11.2 [95% CI: 3.4, 37.1], P = .002, respectively). The 12-month overall survival rate was lower in patients with progressive disease than in those without progression (35% [95% CI: 24, 51] vs 90% [95% CI: 83, 99]; HR, 7.3 [95% CI: 3.9, 13.3]; P < .001). Conclusion Baseline fluorine 18 fluorodeoxyglucose PET/CT metabolic tumor volume was an independent prognostic marker in patients with advanced melanoma who received ipilimumab and nivolumab treatment. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Amir Iravani
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Roslyn Wallace
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Serigne N Lo
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Anna Galligan
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Alison M Weppler
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Rodney J Hicks
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
| | - Shahneen Sandhu
- From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.)
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Yu H, Gu Y, Fan W, Gao Y, Wang M, Zhu X, Wu Z, Liu J, Li B, Wu H, Cheng Z, Wang S, Zhang Y, Xu B, Li S, Shi H. Expert consensus on oncological [ 18F]FDG total-body PET/CT imaging (version 1). Eur Radiol 2022; 33:615-626. [PMID: 35751696 DOI: 10.1007/s00330-022-08960-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND [18F]FDG imaging on total-body PET/CT (TB PET/CT) scanners, with improved sensitivity, offers new potentials for cancer diagnosis, staging, and radiation treatment planning. This consensus provides the protocols for clinical practices with a goal of paving the way for future studies with the total-body scanners in oncological [18F]FDG TB PET/CT imaging. METHODS The consensus was summarized based on the published guidelines and peer-reviewed articles of TB PET/CT in the literature, along with the opinions of the experts from major research institutions with a total of 40,000 cases performed on the TB PET/CT scanners. RESULTS This consensus describes the protocols for routine and dynamic [18F]FDG TB PET/CT scanning focusing on the reduction of imaging acquisition time and FDG injected activity, which may serve as a reference for research and clinic oncological PET/CT studies. CONCLUSION This expert consensus focuses on the reduction of acquisition time and FDG injected activity with a TB PET/CT scanner, which may improve the patient throughput or reduce the radiation exposure in daily clinical oncologic imaging. KEY POINTS • [18F]FDG-imaging protocols for oncological total-body PET/CT with reduced acquisition time or with different FDG activity levels have been summarized from multicenter studies. • Total-body PET/CT provides better image quality and improved diagnostic insights. • Clinical workflow and patient management have been improved.
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Affiliation(s)
- Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China.,Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yushen Gu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China.,Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wei Fan
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, No. 651 Dongfendong Road, Guangzhou, 510060, China
| | - Yongju Gao
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Henan Key Laboratory of Noval Molecular Probes and Clinical Translation in Nuclear Medicine, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Meiyun Wang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Henan Key Laboratory of Noval Molecular Probes and Clinical Translation in Nuclear Medicine, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Xiaohua Zhu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Zhifang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Collaborative Innovation Center for Molecular Imaging Precision Medicine, Taiyuan, 030001, China
| | - Jianjun Liu
- Department of Nuclear Medicine, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 PuJian Road, Shanghai, 200127, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hubing Wu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Zhaoping Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Shuxia Wang
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China.,Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Collaborative Innovation Center for Molecular Imaging Precision Medicine, Taiyuan, 030001, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, 200032, China. .,Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China. .,Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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7
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Hribernik N, Huff DT, Studen A, Zevnik K, Klaneček Ž, Emamekhoo H, Škalic K, Jeraj R, Reberšek M. Quantitative imaging biomarkers of immune-related adverse events in immune-checkpoint blockade-treated metastatic melanoma patients: a pilot study. Eur J Nucl Med Mol Imaging 2022; 49:1857-1869. [PMID: 34958422 PMCID: PMC9016045 DOI: 10.1007/s00259-021-05650-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/05/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop quantitative molecular imaging biomarkers of immune-related adverse event (irAE) development in malignant melanoma (MM) patients receiving immune-checkpoint inhibitors (ICI) imaged with 18F-FDG PET/CT. METHODS 18F-FDG PET/CT images of 58 MM patients treated with anti-PD-1 or anti-CTLA-4 ICI were retrospectively analyzed for indication of irAE. Three target organs, most commonly affected by irAE, were considered: bowel, lung, and thyroid. Patient charts were reviewed to identify which patients experienced irAE, irAE grade, and time to irAE diagnosis. Target organs were segmented using a convolutional neural network (CNN), and novel quantitative imaging biomarkers - SUV percentiles (SUVX%) of 18F-FDG uptake within the target organs - were correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. Patients who did not experience irAE were used to establish normal ranges for target organ 18F-FDG uptake. RESULTS A total of 31% (18/58) patients experienced irAE in the three target organs: bowel (n=6), lung (n=5), and thyroid (n=9). Optimal percentiles for identifying irAE were bowel (SUV95%, AUROC=0.79), lung (SUV95%, AUROC=0.98), and thyroid (SUV75%, AUROC=0.88). Optimal cut-offs for irAE detection were bowel (SUV95%>2.7 g/mL), lung (SUV95%>1.7 g/mL), and thyroid (SUV75%>2.1 g/mL). Normal ranges (95% confidence interval) for the SUV percentiles in patients without irAE were bowel [1.74, 2.86 g/mL], lung [0.73, 1.46 g/mL], and thyroid [0.86, 1.99 g/mL]. CONCLUSIONS Increased 18F-FDG uptake within irAE-affected organs provides predictive information about the development of irAE in MM patients receiving ICI and represents a potential quantitative imaging biomarker for irAE. Some irAE can be detected on 18F-FDG PET/CT well before clinical symptoms appear.
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Affiliation(s)
- Nežka Hribernik
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel T Huff
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Carbone Cancer Centre, Madison, WI, USA
| | - Andrej Studen
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Katarina Zevnik
- Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Žan Klaneček
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Hamid Emamekhoo
- University of Wisconsin Carbone Cancer Centre, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Katja Škalic
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Jeraj
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Carbone Cancer Centre, Madison, WI, USA
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Martina Reberšek
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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8
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Translating Molecules into Imaging—The Development of New PET Tracers for Patients with Melanoma. Diagnostics (Basel) 2022; 12:diagnostics12051116. [PMID: 35626272 PMCID: PMC9139963 DOI: 10.3390/diagnostics12051116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 01/27/2023] Open
Abstract
Melanoma is a deadly disease that often exhibits relentless progression and can have both early and late metastases. Recent advances in immunotherapy and targeted therapy have dramatically increased patient survival for patients with melanoma. Similar advances in molecular targeted PET imaging can identify molecular pathways that promote disease progression and therefore offer physiological information. Thus, they can be used to assess prognosis, tumor heterogeneity, and identify instances of treatment failure. Numerous agents tested preclinically and clinically demonstrate promising results with high tumor-to-background ratios in both primary and metastatic melanoma tumors. Here, we detail the development and testing of multiple molecular targeted PET-imaging agents, including agents for general oncological imaging and those specifically for PET imaging of melanoma. Of the numerous radiopharmaceuticals evaluated for this purpose, several have made it to clinical trials and showed promising results. Ultimately, these agents may become the standard of care for melanoma imaging if they are able to demonstrate micrometastatic disease and thus provide more accurate information for staging. Furthermore, these agents provide a more accurate way to monitor response to therapy. Patients will be able to receive treatment based on tumor uptake characteristics and may be able to be treated earlier for lesions that with traditional imaging would be subclinical, overall leading to improved outcomes for patients.
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9
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Xiao J, Su M, Wang D. Primary Malignant Melanoma of the Oropharynx Presented on 18F-FDG PET/CT. Clin Nucl Med 2021; 46:741-743. [PMID: 33630806 DOI: 10.1097/rlu.0000000000003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary malignant melanoma in the oropharynx is extremely rare. A 49-year-old man presented with a 3-month history of progressive dysphagia. An outside CT scan of the head and neck showed a space-occupying lesion in the oropharynx. Staging with FDG PET/CT demonstrated a hypermetabolic mass in the right wall of the oropharynx. A biopsy revealed malignant melanoma. The patient underwent total resection of the tumor, with no recurrence after 6-month follow-up.
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Affiliation(s)
- JingXing Xiao
- From the Department of Nuclear Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
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10
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Van de Wiele C, Juanito G, Vander BK, Lawal I, De Spiegeleer B, Sathekge M, Maes A. Practical Considerations When Interpreting FDG PET/CT Imaging for Staging and Treatment Response Assessment in Melanoma Patients. Semin Nucl Med 2021; 51:544-553. [PMID: 34246450 DOI: 10.1053/j.semnuclmed.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While FDG PET/CT bears a high sensitivity and specificity for the staging of stage III and IV melanoma as well as for the purpose of melanoma recurrence detection, overall results tend to vary from one part of the body to another as well as for melanoma from cutaneous or choroidal origin. In this paper, organ or site-related differences in sensitivity and specificity in melanoma patients, both from cutaneous and choroidal origin, as well as their impact on clinical decision making are discussed. Furthermore, with the advent of immunotherapy for the treatment of malignant melanoma, post-treatment related potential false positive findings have emerged, the knowledge of which is essential for accurate treatment response assessment. These post-treatment related potential false positive findings are summarized in this paper so as to help the nuclear medicine physician in avoiding erroneous interpretation of acquired FDG PET/CT images in melanoma patients receiving immuntherapy.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Diagnostic Sciences, University Ghent, Ghent, Belgium.
| | | | - Borght K Vander
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Bart De Spiegeleer
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphological Sciences, University Leuven, Leuven, Belgium
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11
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Ozdemir S, McCook B, Klassen C. Whole-Body versus Routine Skull Base to Mid-thigh 18F-Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in Patients with Malignant Melanoma. J Clin Imaging Sci 2020; 10:47. [PMID: 32874752 PMCID: PMC7451172 DOI: 10.25259/jcis_93_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives: The objectives of this study are to assess the utility of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) (skull vertex to toes) imaging relative to the standard field of view (skull base to mid-thigh) in patients with primary melanoma site that is not located in the lower extremities. Material and Methods: The primary site of the melanoma and metastatic disease was determined based on 18F-FDG PET/CT findings in 26 patients. The FDG avid sites were tabulated as the primary site, lower extremity, brain, and other sites. The hypothesis is that routine skull base to mid-thigh versus whole-body 18F-FDG PET/CT in patients with malignant melanoma will not change management. Results: Patients (26) were divided into those with primary melanoma site in either the lower extremities (six patients) or other site (20 patients). Four of the six patients with the primary site in the lower extremities also had positive findings in the ipsilateral inguinal lymph nodes. One of the patients with a positive inguinal lymph node had metastatic sites in the external iliac region and lungs on the initial study. On follow-up imaging, this patient also exhibited diffuse metastatic disease, including a lower extremity. None of the remaining patients in this group had positive findings other than the primary site in the lower extremity. Of the remaining 20 patients with the primary site not in the lower extremity, one had diffuse metastatic disease that included a lower extremity. However, lower extremity involvement would not change patient management in this case. A second patient in this group had diffuse metastatic disease that also involved the brain. However, no metastatic disease was present in the lower extremities in this patient. None of the remaining 18 patients in this group had metastatic disease in a lower extremity. Two patients in the entire study group of 26 had brain metastasis on contrast-enhanced head CT, with one having multiple brain metastasis. PET failed to demonstrate some of the brain lesions. In the other patient with solitary brain metastasis detected on contrast-enhanced head CT, PET was negative. Conclusion: 18F-FDG PET/CT imaging of the lower extremity may not be justified if the primary neoplasm is not located in the lower extremities. Elimination of lower extremity imaging will reduce scanning time and additional radiation exposure. Similarly, PET/CT imaging of the brain may not be justified if contrast-enhanced CT or magnetic resonance imaging of the head is already obtained since these are more sensitive.
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Affiliation(s)
- Savas Ozdemir
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
| | - Barry McCook
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
| | - Christopher Klassen
- Department of Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
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12
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Yılmaz H, Orhan E, Şahin E, Olguner AA, Arpacı E. Efficacy of positron emission tomography and computed tomography in clinical staging of cutaneous malignant melanoma. Dermatol Ther 2020; 33:e13304. [PMID: 32160381 DOI: 10.1111/dth.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
Accurate staging is very important for determining the prognosis and appropriate treatment for malignant melanoma (MM). The aim of this study is to determine the effectiveness of positron emission tomography and computed tomography (PET/CT) imaging in staging MM. Patients diagnosed with MM who then underwent PET/CT metastasis before treatment were assessed retrospectively. For each patient, the following variables were recorded: Breslow thickness, Clark's level, number of mitoses, the presence of ulceration detected in the pathology report, and the presence of lymph nodes and/or distant metastases detected by PET/CT. The pathology and PET/CT reports of 139 patients (79 female and 60 male) were retrospectively evaluated for staging after MM diagnosis. Patients with a Breslow thickness greater than 3.4 mm and Clark's level of 4 to 5 were found to be statistically significantly higher with regional lymph node metastasis after PET/CT scans. Patients with Breslow thickness greater than 2.85 mm and Clark's level of 4 to 5 were found to be statistically significantly higher with distant metastasis after PET/CT scan. The results of our study suggest that PET/CT imaging for metastasis scanning, starting with T2 patients, may be used in MM staging to reduce the need for sentinel lymph node (SLN) biopsy and lymph node dissection.
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Affiliation(s)
- Harun Yılmaz
- Department of Plastic Surgery, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Erkan Orhan
- Department of Plastic Surgery, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Ertan Şahin
- Department of Nuclear Medicine, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Anıl A Olguner
- Department of Plastic Surgery, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Enver Arpacı
- Department of Plastic Surgery, Başkent University, School of Medicine, Konya, Turkey
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13
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Tan AC, Emmett L, Lo S, Liu V, Kapoor R, Carlino MS, Guminski AD, Long GV, Menzies AM. FDG-PET response and outcome from anti-PD-1 therapy in metastatic melanoma. Ann Oncol 2019; 29:2115-2120. [PMID: 30137228 DOI: 10.1093/annonc/mdy330] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Immune checkpoint inhibitor therapy has resulted in impressive and durable clinical activity for many cancers including melanoma; however, there remain few reliable predictors for long-term response. This study investigated whether [18F]2-fluoro-2-deoxy-D-glucose (FDG-PET) imaging may better predict long-term outcomes compared with standard computed tomography (CT) response criteria. Patients and methods Retrospective analysis of metastatic melanoma patients treated with anti-PD-1-based immunotherapy with baseline and 1-year FDG-PET and CT imaging at Melanoma Institute Australia. One-year response was determined using RECIST for CT and EORTC criteria for PET, coded as complete response (CR or CMR), partial response (PR or PMR), stable disease (SD or SMD) or progressive disease (PD or PMD). Progression-free survival (PFS) was determined from the 1-year landmark. Results Patients (n = 104) were evaluated with median follow-up 30.1 months and 98% remain alive. Most received anti-PD-1 as monotherapy (67%) or combined with ipilimumab (31%). At 1 year, 28% had CR, 66% had PR and 6% had SD on CT, while 75% had CMR, 16% PMR and 9% SMD/PMD on PET. CMR was observed in 68% of patients with PR on CT. RECIST PFS post 1-year landmark was similar in patients with CR versus PR/SD, but improved in patients with CMR versus non-CMR {median not reached [NR] versus 12.8 month; hazard ratio [HR] 0.06 [95% confidence interval (CI) 0.02-0.23]; P < 0.01}. In patients with PR on CT, PFS was improved in patients with PR + CMR versus PR + non-CMR (median NR versus 12.8 months; HR 0.07 [95% CI 0.02-0.27]; P < 0.01). In the 78 CMR patients, 78% had discontinued treatment and 96% had ongoing response. Conclusions Whilst only a small proportion of patients have a CR at 1 year, most patients with a PR have CMR on PET. Almost all patients with CMR at 1 year have ongoing response to therapy thereafter. PET may have utility in predicting long-term benefit and help guide discontinuation of therapy.
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Affiliation(s)
- A C Tan
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - L Emmett
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia
| | - S Lo
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - V Liu
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - R Kapoor
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - M S Carlino
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - A D Guminski
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
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14
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Dinnes J, Ferrante di Ruffano L, Takwoingi Y, Cheung ST, Nathan P, Matin RN, Chuchu N, Chan SA, Durack A, Bayliss SE, Gulati A, Patel L, Davenport C, Godfrey K, Subesinghe M, Traill Z, Deeks JJ, Williams HC. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database Syst Rev 2019; 7:CD012806. [PMID: 31260100 PMCID: PMC6601698 DOI: 10.1002/14651858.cd012806.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | | | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Seau Tak Cheung
- Dudley Hospitals Foundation Trust, Corbett HospitalDepartment of DermatologyWicarage RoadStourbridgeUKDY8 4JB
| | - Paul Nathan
- Mount Vernon HospitalMount Vernon Cancer CentreRickmansworth RoadNorthwoodUKHA6 2RN
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Sue Ann Chan
- City HospitalBirmingham Skin CentreDudley RdBirminghamUKB18 7QH
| | - Alana Durack
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustDermatologyHills RoadCambridgeUKCB2 0QQ
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Abha Gulati
- Barts Health NHS TrustDepartment of DermatologyWhitechapelLondonUKE11BB
| | - Lopa Patel
- Royal Stoke HospitalPlastic SurgeryStoke‐on‐TrentStaffordshireUKST4 6QG
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Manil Subesinghe
- King's College LondonCancer Imaging, School of Biomedical Engineering & Imaging SciencesLondonUK
| | - Zoe Traill
- Oxford University Hospitals NHS TrustChurchill Hospital Radiology DepartmentOxfordUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Delgado Bolton RC, Calapaquí-Terán AK, Giammarile F, Rubello D. Role of 18F-FDG-PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Delgado Bolton RC, Calapaquí-Terán AK, Giammarile F, Rubello D. Role of 18F-FDG PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review. Rev Esp Med Nucl Imagen Mol 2019; 38:229-233. [PMID: 31202725 DOI: 10.1016/j.remn.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 12/11/2022]
Abstract
Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently 18F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by 18F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating 18F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up 18F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, 18F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies.
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Affiliation(s)
- Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine at the San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR) in Logroño(La Rioja), Spain
| | - Adriana K Calapaquí-Terán
- Department of Pathology at the University Hospital Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Domenico Rubello
- Department of Imaging (Nuclear Medicine, Medical Physics, Radiology) and of Clinical Laboratory (Laboratory, Transfusional Centre, Microbiology, Pathology, Rovigo Hospital, Italy.
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Skeletal muscle and solitary bone metastases from malignant melanoma: multimodality imaging and oncological outcome. Melanoma Res 2019; 28:562-570. [PMID: 29975212 PMCID: PMC6221392 DOI: 10.1097/cmr.0000000000000466] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Malignant melanoma solitary metastases to bone or skeletal muscle occur in 0.8% of patients. The aim of this study was to evaluate features of skeleton and muscle metastases with multimodality imaging and review the oncological outcome. Thirteen patients with melanoma metastases from January 2006 to February 2016 were included. Histologic confirmation was obtained. Imaging studies included computed tomography (CT), MRI, and/or positron emission tomography/CT. Treatment received and BRAF status were recorded. Differences in BRAF status and overall survival (OS) were analyzed using the χ2-test. Associations between OS and metastases were analyzed using Cox proportional models. Nine (69%) patients showed osseous involvement. Lower extremity bones were affected in three (23%) patients: first toe, right calcaneal spurs, and knee. The spine was involved in three (23%) patients. In two (15%) patients, the pelvic bones were involved. In one (8%) patient, the temporal bone was affected. Nine (70%) patients had a history of malignant melanoma, with a median time to progression of 28 months. The median OS was 18 months: 24 months in patients with a history of melanoma and 3 months in patients with metastases at first diagnosis. The median follow-up duration was 28 months. BRAF mutant versus wild-type tumors showed significant differences in OS (P=0.03). The hazard ratio for death in the metastatic group at diagnosis was 6.83, 95% confidence interval: 1.060–144.072 (P=0.04). Solitary metastases from melanoma to the skeleton and muscle are rare. CT, MRI, and positron emission tomography/CT are useful for the evaluation of musculoskeletal findings. Image findings are not definitive for diagnosing a malignant solitary lesion; thus, a pathologic confirmation with a biopsy is recommended.
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Nozaki I, Hato S, Takahata H, Hori S, Matsumoto T, Nishina T, Kurita A. A Resected Case of Primary Malignant Melanoma of the Esophagus—Early Detection of Recurrence by FDG-PET/CT. Int Surg 2018; 102:459-464. [DOI: 10.9738/intsurg-d-14-00302.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Primary malignant melanoma of the esophagus (PMME) is a rare, aggressive, therapy-resistant malignant tumor arising from esophageal mucosal melanocytes. It has been reported that fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has a clinical impact on PMME diagnosis; however, it remains unclear whether postoperative surveillance using FDG-PET/CT is useful for PMME patients. In this case study, FDG-PET/CT detected the recurrent tumors in their early stage after a curative resection of PMME. We report on a case of a 67-year-old Japanese male admitted to our hospital for the evaluation of polypoid tumors of the esophagogastric junction, which were diagnosed as PMME. He was treated with a curative resection by esophagectomy and 6 cycles of adjuvant chemotherapy of DAV (dacarbazine, nimustine, and vincristine). However, the PMME recurred 26 months after the surgery when surveillance FDG-PET/CT detected the recurrent tumors in their early stage. FDG-PET/CT may be useful to detect recurrence in the postoperative surveillance phase for PMME patients.
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Affiliation(s)
| | | | | | - Shinichirou Hori
- Department of Internal Medicine, Shikoku Cancer Center, Matsuyama, Japan
| | | | - Tomohiro Nishina
- Department of Internal Medicine, Shikoku Cancer Center, Matsuyama, Japan
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19
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Perissinotti A, Rietbergen DDD, Vidal-Sicart S, Riera AA, Olmos RA. Melanoma & nuclear medicine: new insights & advances. Melanoma Manag 2018; 5:MMT06. [PMID: 30190932 PMCID: PMC6122522 DOI: 10.2217/mmt-2017-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/29/2018] [Indexed: 12/16/2022] Open
Abstract
The contribution of nuclear medicine to management of melanoma patients is increasing. In intermediate-thickness N0 melanomas, lymphoscintigraphy provides a roadmap for sentinel node biopsy. With the introduction of single-photon emission computed tomography images with integrated computed tomography (SPECT/CT), 3D anatomic environments for accurate surgical planning are now possible. Sentinel node identification in intricate anatomical areas (pelvic cavity, head/neck) has been improved using hybrid radioactive/fluorescent tracers, preoperative lymphoscintigraphy and SPECT/CT together with modern intraoperative portable imaging technologies for surgical navigation (free-hand SPECT, portable gamma cameras). Furthermore, PET/CT today provides 3D roadmaps to resect 18F-fluorodeoxyglucose-avid melanoma lesions. Simultaneously, in advanced-stage melanoma and recurrences, 18F-fluorodeoxyglucose-PET/CT is useful in clinical staging and treatment decision as well as in the evaluation of therapy response. In this article, we review new insights and recent nuclear medicine advances in the management of melanoma patients.
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Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Daphne DD Rietbergen
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Ana A Riera
- Department of Nuclear Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Carretera del Rosario 145, 08010 SC de Tenerife, Spain
| | - Renato A Valdés Olmos
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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20
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Cha J, Kim S, Wang J, Yun M, Cho A. Evaluation of 18F-FDG PET/CT Parameters for Detection of Lymph Node Metastasis in Cutaneous Melanoma. Nucl Med Mol Imaging 2018; 52:39-45. [PMID: 29391911 PMCID: PMC5777962 DOI: 10.1007/s13139-017-0495-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in the detection of regional lymph node (LN) metastasis in patients with cutaneous melanoma. METHODS We evaluated patients with cutaneous melanoma who underwent FDG PET/CT for initial staging or recurrence evaluation. A total of 103 patients were enrolled, and 165 LNs were evaluated. LNs that were confirmed pathologically or by follow-up imaging were included in this study. PET parameters, including maximum standardized uptake value (SUVmax), total lesion glycolysis and tumour-to-liver ratio, were used to determine the presence of metastases, and the results were compared with CT-determined LN metastasis. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the FDG PET parameters. RESULTS A total of 93 LNs were malignant, and 84 LNs were smaller than 10 mm. In all 165 LNs, an SUVmax of >2.51 showed a sensitivity of 73.1%, a specificity of 88.9%, and an accuracy of 80.0% in detecting metastatic LNs. CT showed a higher specificity (87.3%) and lower accuracy (65.5%). For non-enlarged regional LNs (<10 mm), an SUVmax cut-off value of 1.4 showed the highest negative predictive value (81.3%). For enlarged LNs (≥10 mm), an SUVmax cut-off value of 2.4 showed the highest sensitivity (90.7%) and accuracy (88.9%) in detecting metastatic LNs. CONCLUSIONS In patients with cutaneous melanoma, an SUVmax of >2.4 showed a high sensitivity (91%) and accuracy (89%) in detecting metastasis in LNs ≥1 cm, and LNs <1 cm with an SUVmax <1.4 were likely to be benign.
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Affiliation(s)
- Jongtae Cha
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul, 120-752 South Korea
| | - Soyoung Kim
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul, 120-752 South Korea
| | - Jiyoung Wang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul, 120-752 South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul, 120-752 South Korea
| | - Arthur Cho
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul, 120-752 South Korea
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21
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Delgado Bolton RC, Giammarile F. Bone radionuclide therapy and increased survival with radium-223 is the way to go for nuclear medicine: the offer that oncologists cannot refuse. Eur J Nucl Med Mol Imaging 2018; 45:822-823. [PMID: 29333576 DOI: 10.1007/s00259-017-3913-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Roberto C Delgado Bolton
- Department of Diagnostic Imaging and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain.
| | - Francesco Giammarile
- International Atomic Energy Agency (IAEA), Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
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22
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Wouters MW, Michielin O, Bastiaannet E, Beishon M, Catalano O, Del Marmol V, Delgado-Bolton R, Dendale R, Trill MD, Ferrari A, Forsea AM, Kreckel H, Lövey J, Luyten G, Massi D, Mohr P, Oberst S, Pereira P, Prata JPP, Rutkowski P, Saarto T, Sheth S, Spurrier-Bernard G, Vuoristo MS, Costa A, Naredi P. ECCO essential requirements for quality cancer care: Melanoma. Crit Rev Oncol Hematol 2018; 122:164-178. [PMID: 29458785 DOI: 10.1016/j.critrevonc.2017.12.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. MELANOMA ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma.
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Affiliation(s)
- Michel W Wouters
- European Society of Surgical Oncology (ESSO); Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olivier Michielin
- European Society for Medical Oncology (ESMO); Department of Oncology, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Esther Bastiaannet
- International Society of Geriatric Oncology (SIOG); Department of Surgery/Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Orlando Catalano
- European Society of Radiology (ESR); Department of Radiology, National Cancer Institute Fondazione Pascale, Naples, Italy
| | - Veronique Del Marmol
- Association of European Cancer Leagues (ECL); Euromelanoma, European Academy of Dermatology and Venereology (EADV); Department of Dermatology and Venereology, Erasme Hospital, ULB, Brussels, Belgium
| | - Roberto Delgado-Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Rémi Dendale
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Institut Curie, Paris, France
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Andrea Ferrari
- European Society for Paediatric Oncology (SIOPE); Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ana-Maria Forsea
- European Association of Dermato Oncology (EADO); Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hannelore Kreckel
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, University Hospital Giessen and Marburg, Giessen, Germany
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Gre Luyten
- Ocular Oncology Group (OOG); Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniela Massi
- European Society of Pathology (ESP); Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Mohr
- European Society of Skin Cancer Prevention (EUROSKIN); Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cambridge Cancer Centre, Cambridge, UK
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Clinics Heilbronn, Karl-Ruprecht-University of Heidelberg, Heilbronn, Germany
| | - João Paulo Paiva Prata
- European Oncology Nursing Society (EONS); Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Piotr Rutkowski
- European Organisation for Research and Treatment of Cancer (EORTC); Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Comprehensive Cancer Center, Department of Palliative Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sapna Sheth
- European CanCer Organisation, Brussels, Belgium
| | - Gilly Spurrier-Bernard
- European CanCer Organisation (ECCO) Patient Advisory Committee; Melanoma Patient Network Europe; Paris, France
| | - Meri-Sisko Vuoristo
- Association of European Cancer Leagues (ECL); Pirkanmaa Cancer Society, Tampere, Finland
| | | | - Peter Naredi
- European CanCer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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23
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Tchernev G, Popova LV. PET Scan Misses Cutaneous Melanoma Metastasis with Significant Tumour Size and Tumour Thickness. Open Access Maced J Med Sci 2017; 5:963-966. [PMID: 29362627 PMCID: PMC5771303 DOI: 10.3889/oamjms.2017.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 10/28/2017] [Accepted: 10/29/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although PET-scan is an advanced, innovative and widely used method for monitoring patients with different types of cancer diseases, it is important to note that its application in patients with cutaneous melanoma is limited and should be reconsidered. CASE REPORT To affirm this new statement, we are presenting a case from our clinical practice of a patient with melanoma of the interdigital space (with resected in sano primary melanoma and performed complete lymphadenectomy) that showed locoregional and systemic progression in two months post operation. The PET scan performed within the second hospitalization (and before the second operation) did not detect the presence of any cutaneous metastases, which were clinically and histologically verified after the second operative procedure. CONCLUSIONS This data suggests that shortly more reliable and sensitive imaging methods for monitoring patients with cutaneous melanoma should be found. Having in mind that our patient has been operated twice in the area of the primary lesion (as the surgical wound underwent secondary healing), theoretically, the abundant cicatrization could have led to reduced glucose uptake in the surrounded cancerous tissue. Monitoring of a larger number of patients with locoregional metastases and surgical interventions in different locations would shed light on the observations shared by us.
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Affiliation(s)
- Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic surgery, Medical Institute of Ministry of Interior (MVR-Sofia), General Skobelev 79, 1606, Sofia, Bulgaria
- Onkoderma - Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Liubomira Victor Popova
- Department of Dermatology, Venereology and Dermatologic surgery, Medical Institute of Ministry of Interior (MVR-Sofia), General Skobelev 79, 1606, Sofia, Bulgaria
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24
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Morris MA, Ring CM, Managuli R, Saboury B, Mehregan D, Siegel E, Dasgeb B. Feature analysis of ultrasound elastography image for quantitative assessment of cutaneous carcinoma. Skin Res Technol 2017; 24:242-247. [DOI: 10.1111/srt.12420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- M. A. Morris
- Department of Diagnostic Radiology & Nuclear Medicine; University of Maryland School of Medicine; Baltimore MD USA
- Department of Radiology; Baltimore Veteran's Affairs Medical Center; Baltimore MD USA
- Department of Internal Medicine; Mercy Medical Center; Baltimore MD USA
| | - C. M. Ring
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - R. Managuli
- Department of Diagnostic Radiology; University of Washington Medical Center; Baltimore MD USA
| | - B. Saboury
- Department of Diagnostic Radiology & Nuclear Medicine; University of Maryland School of Medicine; Baltimore MD USA
- Department of Radiology; Baltimore Veteran's Affairs Medical Center; Baltimore MD USA
| | - D. Mehregan
- Department of Dermatology; Wayne State University Medical Center; Detroit MI USA
| | - E. Siegel
- Department of Diagnostic Radiology & Nuclear Medicine; University of Maryland School of Medicine; Baltimore MD USA
- Department of Radiology; Baltimore Veteran's Affairs Medical Center; Baltimore MD USA
| | - B. Dasgeb
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia PA USA
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25
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Dinnes J, Saleh D, Newton-Bishop J, Cheung ST, Nathan P, Matin RN, Chuchu N, Bayliss SE, Takwoingi Y, Davenport C, Godfrey K, O'Sullivan C, Deeks JJ, Williams HC. Tests to assist in the staging of cutaneous melanoma: a generic protocol. Hippokratia 2017. [DOI: 10.1002/14651858.cd012806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jacqueline Dinnes
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Daniel Saleh
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary; Newcastle Hospitals; Newcastle UK
| | - Julia Newton-Bishop
- University of Leeds; Section of Epidemiology and Biostatistics; St James's Hospital Leeds UK LS9 7TF
| | - Seau Tak Cheung
- Dudley Hospitals Foundation Trust, Corbett Hospital; Department of Dermatology; Wicarage Road Stourbridge UK DY8 4JB
| | - Paul Nathan
- Mount Vernon Hospital; Mount Vernon Cancer Centre; Rickmansworth Road Northwood UK HA6 2RN
| | - Rubeta N Matin
- Churchill Hospital; Department of Dermatology; Old Road Headington Oxford UK OX3 7LJ
| | - Naomi Chuchu
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Susan E Bayliss
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Yemisi Takwoingi
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Clare Davenport
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Kathie Godfrey
- The University of Nottingham; c/o Cochrane Skin Group; Nottingham UK
| | | | - Jonathan J Deeks
- University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
| | - Hywel C Williams
- The University of Nottingham; Centre of Evidence Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
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van der Hiel B, Haanen JB, Stokkel MP, Peeper DS, Jimenez CR, Beijnen JH, van de Wiel BA, Boellaard R, van den Eertwegh AJ. Vemurafenib plus cobimetinib in unresectable stage IIIc or stage IV melanoma: response monitoring and resistance prediction with positron emission tomography and tumor characteristics (REPOSIT): study protocol of a phase II, open-label, multicenter study. BMC Cancer 2017; 17:649. [PMID: 28915798 PMCID: PMC5603097 DOI: 10.1186/s12885-017-3626-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with BRAFV600 mutated unresectable stage IIIc or metastatic melanoma, molecular targeted therapy with combined BRAF/MEK-inhibitor vemurafenib plus cobimetinib has shown a significantly improved progression-free survival and overall survival compared to treatment with vemurafenib alone. Nevertheless, the majority of BRAFV600 mutation-positive melanoma patients will eventually develop resistance to treatment. Molecular imaging with 18F-Fluorodeoxyglucose (18F-FDG) PET has been used to monitor response to vemurafenib in some BRAFV600 mutated metastatic melanoma patients, showing a rapid decline of 18F-FDG uptake within 2 weeks following treatment. Furthermore, preliminary results suggest that metabolic alterations might predict the development of resistance to treatment. 18F-Fluoro-3'-deoxy-3'L-fluorothymidine (18F-FLT), a PET-tracer visualizing proliferation, might be more suitable to predict response or resistance to therapy than 18F-FDG. METHODS This phase II, open-label, multicenter study evaluates whether metabolic response to treatment with vemurafenib plus cobimetinib in the first 7 weeks as assessed by 18F-FDG/18F-FLT PET can predict progression-free survival and whether early changes in 18F-FDG/18F-FLT can be used for early detection of treatment response compared to standard response assessment with RECISTv1.1 ceCT at 7 weeks. Ninety patients with BRAFV600E/K mutated unresectable stage IIIc/IV melanoma will be included. Prior to and during treatment all patients will undergo 18F-FDG PET/CT and in 25 patients additional 18F-FLT PET/CT is performed. Histopathological tumor characterization is assessed in a subset of 40 patients to unravel mechanisms of resistance. Furthermore, in all patients, blood samples are taken for pharmacokinetic analysis of vemurafenib/cobimetinib. Outcomes are correlated with PET/CT-imaging and therapy response. DISCUSSION The results of this study will help in linking PET measured metabolic alterations induced by targeted therapy of BRAFV600 mutated melanoma to molecular changes within the tumor. We will be able to correlate both 18F-FDG and 18F-FLT PET to outcome and decide on the best modality to predict long-term remissions to combined BRAF/MEK-inhibitors. Results coming from this study may help in identifying responders from non-responders early after the initiation of therapy and reveal early development of resistance to vemurafenib/cobimetinib. Furthermore, we believe that the results can be fundamental for further optimizing individual patient treatment. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02414750. Registered 10 April 2015, retrospectively registered.
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Affiliation(s)
- Bernies van der Hiel
- Department of Nuclear Medicine, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, The Netherlands
| | - John B.A.G. Haanen
- Department of Medical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marcel P.M. Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Daniel S. Peeper
- Department of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Connie R. Jimenez
- Oncoproteomics Laboratory, Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Jos H. Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bart A. van de Wiel
- Department of Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | - REPOSIT study group
- Department of Nuclear Medicine, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncoproteomics Laboratory, Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
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27
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Chacón-Moscoso S, Sanduvete-Chaves S, Sánchez-Martín M. The Development of a Checklist to Enhance Methodological Quality in Intervention Programs. Front Psychol 2016; 7:1811. [PMID: 27917143 PMCID: PMC5114299 DOI: 10.3389/fpsyg.2016.01811] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/02/2016] [Indexed: 11/26/2022] Open
Abstract
The methodological quality of primary studies is an important issue when performing meta-analyses or systematic reviews. Nevertheless, there are no clear criteria for how methodological quality should be analyzed. Controversies emerge when considering the various theoretical and empirical definitions, especially in relation to three interrelated problems: the lack of representativeness, utility, and feasibility. In this article, we (a) systematize and summarize the available literature about methodological quality in primary studies; (b) propose a specific, parsimonious, 12-items checklist to empirically define the methodological quality of primary studies based on a content validity study; and (c) present an inter-coder reliability study for the resulting 12-items. This paper provides a precise and rigorous description of the development of this checklist, highlighting the clearly specified criteria for the inclusion of items and a substantial inter-coder agreement in the different items. Rather than simply proposing another checklist, however, it then argues that the list constitutes an assessment tool with respect to the representativeness, utility, and feasibility of the most frequent methodological quality items in the literature, one that provides practitioners and researchers with clear criteria for choosing items that may be adequate to their needs. We propose individual methodological features as indicators of quality, arguing that these need to be taken into account when designing, implementing, or evaluating an intervention program. This enhances methodological quality of intervention programs and fosters the cumulative knowledge based on meta-analyses of these interventions. Future development of the checklist is discussed.
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Affiliation(s)
- Salvador Chacón-Moscoso
- HUM-649 Innovaciones Metodológicas en Evaluación de Programas, Departamento de Psicología Experimental, Facultad de Psicología, Universidad de SevillaSevilla, Spain
- Universidad Autónoma de ChileSantiago de Chile, Chile
| | - Susana Sanduvete-Chaves
- HUM-649 Innovaciones Metodológicas en Evaluación de Programas, Departamento de Psicología Experimental, Facultad de Psicología, Universidad de SevillaSevilla, Spain
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18F-FDG-PET/CT in the Staging and Management of Melanoma: A Prospective Multicenter Ontario PET Registry Study. Clin Nucl Med 2016; 41:189-93. [PMID: 26447374 DOI: 10.1097/rlu.0000000000000996] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The Ontario PET Registry was established to provide evidence on the clinical impact of 18-FDG-PET/CT (PET) imaging to inform Ontario Health Insurance Plan funding decisions. The melanoma registry assessed the use of melanoma staging by PET in advanced or high-risk melanoma as a useful adjunct to clinical and standard radiologic investigation. MATERIALS AND METHODS Between January 2011 and July 2013, approximately 319 consecutive patients with potentially resectable localized high-risk melanoma or recurrent disease under consideration for metastasectomy underwent PET imaging for staging across 9 institutions in Ontario. Pre-PET stage information was provided by the referring clinician and compared with post-PET stage. The ability of PET to reclassify disease from M0 to M1 status was assessed. The registry data were then linked to provincial administrative databases using deidentified health insurance numbers to determine PET stage-based rates of systemic therapy, radiotherapy, and surgery. RESULTS There was a significant increase in stage to M1 status after PET in 56 of 319 patients (17.6%) (P < 0.0001). There was no significant relationship between upstaging with PET and the proportion of patients receiving radiation therapy (P = 0.066) or systemic therapy (P = 0.072). There was a significant relationship between upstaging with PET and the proportion of patients undergoing surgical resection of metastases distant to the primary melanoma site (P = 0.034). CONCLUSIONS This prospective, multicenter registry of high-risk or advanced melanoma found that PET significantly upstages patients and impacts surgical management.
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Frary EC, Gad D, Bastholt L, Hess S. The role of FDG-PET/CT in preoperative staging of sentinel lymph node biopsy-positive melanoma patients. EJNMMI Res 2016; 6:73. [PMID: 27709489 PMCID: PMC5052236 DOI: 10.1186/s13550-016-0228-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/21/2016] [Indexed: 01/23/2023] Open
Abstract
Background On April 1, 2015, Odense University Hospital (OUH) began a new diagnostic strategy, wherein all malignant melanoma (MM) patients in the Region of Southern Denmark with a positive sentinel lymph node biopsy (SLNB) underwent FDG-PET/CT preoperatively prior to lymph node dissection (LND). The purpose of this study is to determine FDG-PET/CT’s efficacy in finding distant metastasis in the first year after the implementation of this new strategy, and to what extent these findings influence subsequent diagnostic testing and treatment in this patient group. We conducted a retrospective multicenter cohort study which included all patients with MM from all hospitals in the Region of Southern Denmark from April 1, 2015 to April 1, 2016 found to be SLNB-positive who subsequently underwent FDG-PET/CT. Patient information was acquired from the Danish Melanoma Database and was cross-referenced with OUH’s patient records. The data was analyzed for a number of parameters including FDG-PET/CT findings and treatment strategy. Median follow-up time was 7 months. Results A total of 47 patients were eligible from the first year of this new diagnostic strategy. One patient was excluded due to undergoing LND prior to FDG-PET/CT. Thus, 46 patients were included in this study. Ultimately, preoperative FDG-PET/CT neither uncovered any distant metastases nor led to any alterations in treatment strategy in this patient group. Conclusions Surprisingly, this new diagnostic strategy did not find any MM metastases or uncover anything else of relevance. FDG-PET/CT did, however, provide false positive findings in 13 % (6/46) of these patients. These scans triggered additional, predominantly invasive, procedures, which did not ultimately have an impact on the therapeutic strategy. Thus, these findings indicate a need for re-evaluation of this new diagnostic strategy as well as the necessity for further clinical trials evaluating FDG-PET/CT’s utility in this clinical setting.
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Affiliation(s)
- Evan C Frary
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Dorte Gad
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.,Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, Finsengade 10, 6700, Esbjerg, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Wisløvparken 19, 3, 5000, Odense C, Denmark
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Breslow thickness and 18 F-FDG PET/CT results in initial staging of cutaneous melanoma: Can a cut-off point be established? Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ortega-Candil A, Rodríguez-Rey C, Cano-Carrizal R, Cala-Zuluaga E, González Larriba JL, Jiménez-Ballvé A, Fuentes-Ferrer ME, Cabrera-Martín MN, Pérez-Castejón MJ, García García-Esquinas M, Lapeña-Gutierrez L, Carreras-Delgado JL. Breslow thickness and (18)F-FDG PET-CT result in initial staging of cutaneous melanoma: Can a cut-off point be established? Rev Esp Med Nucl Imagen Mol 2015; 35:96-101. [PMID: 26597332 DOI: 10.1016/j.remn.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
Abstract
AIM To establish a Breslow Thickness (BT) cut-off point for indication of PET-CT of cutaneous melanoma in early stages and evaluate its prognostic value. MATERIAL AND METHODS Retrospective analysis of 347 PET-CT studies with diagnosis of melanoma, of which 108 were performed for initial staging. Thirty-one patients were excluded, and a final sample of 77 patients remained. A ROC curve analysis was performed to establish an optimal cut-off point. A survival analysis was performed, considering death assignable to melanoma as the main event, for the evaluation of its prognostic value. RESULTS Forty-seven (61.04%) of all 77 patients selected were men, and 11 (14.29%) had a positive PET-CT result. Mean age was 65.17±15.00 years. The median BT in patients with a negative PET-CT result was 2.75 mm (IQR 1.83-4.50) and in the positive group 6.25 mm (IQR 5.40-7.50) (P=.0013). In the ROC curve analysis (AUC 0.804, SE 0.054), an optimal value of 5 mm BT with the following values was obtained: sensitivity 90.91%, specificity 78.79%, negative predictive value (NPV) 98.1%, positive predictive value (PPV) 41.7%, diagnostic OR 37.1, and accuracy 80.52%. Mean follow-up was 18.66±14,35 months, detecting 2/53 (3.77%) deaths in the BT<5 mm group, and 7/24 (29.17%) in the BT≥5 mm group. Survival curves between both groups were significantly different (P=.0013). CONCLUSIONS A 5 mm cut-off point correctly distinguishes those patients with positive PET-CT from those with negative results in the early stages of cutaneous melanoma; therefore it could be included in initial staging of this subgroup of patients.
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Affiliation(s)
- A Ortega-Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
| | - C Rodríguez-Rey
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - R Cano-Carrizal
- Servicio de Cardiología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - E Cala-Zuluaga
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - J L González Larriba
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - A Jiménez-Ballvé
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M E Fuentes-Ferrer
- Unidad de Gestión Clínica de Medicina Preventiva, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M N Cabrera-Martín
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M J Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M García García-Esquinas
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - L Lapeña-Gutierrez
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - J L Carreras-Delgado
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
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Pfannenberg C, Schwenzer N. [Whole-body staging of malignant melanoma: advantages, limitations and current importance of PET-CT, whole-body MRI and PET-MRI]. Radiologe 2015; 55:120-6. [PMID: 25589421 DOI: 10.1007/s00117-014-2762-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cross-sectional imaging methods are currently the standard methods for staging of advanced melanoma. The former time-consuming and expensive multimodality approach is increasingly being replaced by novel whole-body (WB) staging methods, such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET-CT) and whole-body magnetic resonance imaging (WBMRI) because they offer a complete head-to-toe coverage of the patient in a single examination with an accurate and sensitive detection of tumor spread. Several studies in patients with advanced melanoma revealed that PET-CT is more sensitive and specific than conventional modalities, such as CT alone resulting in a change of management in up to 30 % of cases. Due to the limited sensitivity of PET for lesions smaller than 1 cm, PET-CT is not useful for the initial work-up of patients with stage I and II melanoma but has proven to be superior for detection of distant metastases, which is essential prior to surgical metastasectomy. If PET-CT is not available WB-CT or WB-MRI can alternatively be used and WB-MRI including diffusion-weighted imaging (DWI) has become a real alternative for staging of melanoma patients. So far, however, only few reports suffering from small numbers of cases and heterogeneous design have compared the diagnostic performance of WB-MRI and PET-CT. The preliminary results indicate a high overall diagnostic accuracy of both methods; however, these methods differ in organ-based detection rates: PET-CT was more accurate in N-staging and detection of lung and soft tissue metastases whereas WB-MRI was superior in detecting liver, bone and brain metastases. The value of PET-MRI for staging of advanced melanoma is the subject of ongoing clinical studies.
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Affiliation(s)
- C Pfannenberg
- Abteilung Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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Norum J, Søndergaard U, Traasdahl E, Nieder C, Tollåli G, Andersen G, Sundset R. PET-CT in the sub-arctic region of Norway 2010-2013. At the edge of what is possible? BMC Med Imaging 2015; 15:36. [PMID: 26316132 PMCID: PMC4551695 DOI: 10.1186/s12880-015-0073-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 07/17/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is challenging to obtain a similar access to positron emission tomography/computed tomography (PET-CT) within the whole region served. In the subarctic and arctic region of Norway, significant distances, weather conditions and seasonable darkness have been challenging when the health care provider has aimed for a high quality PET-CT service with similar availability to all inhabitants. METHODS The PET-CT service at the University Hospital of North Norway (UNN) was established in May 2010. The glucose analogue tracer fluorine-18 fluorodeoxyglucose (FDG) was delivered from Helsinki, Finland. An ambulatory PET-CT scanner was initially employed and a permanent local one was introduced in October 2011. In March 2014, we analysed retrospectively all data on the PET-CT exams performed at the Section of Nuclear Medicine, Department of Radiology during a 32 months time period 2010-13. The following patient data were recorded: gender, age, diagnosis, residence and distance of travelling. There were in total 796 exams in 706 patients. RESULTS Four hundred sixty-one PET-CT exams per million inhabitants were, on average, performed per year. Lung cancer (32.7%), malignant melanoma (11.3%), colorectal cancer (10.9%) and lymphoma (9.7%) constituted two-thirds of all exams. Three-fourths were males and the median age was 63.5 years (range 15.2-91.4 years). The access to PET-CT exam varied within the region. The southern county (Nordland) experienced a significantly less access (p < 0.0001) to the regional service. Except for malignant melanoma, this finding was observed in all major cancer subgroups. In colorectal cancer and lymphoma a lower consumption of PET-CT was also observed in the northeastern county (Finnmark). Patients' mean distance of travelling by car (one way) was 373 km (median 313 km, range 5-936 km). CONCLUSION PET-CT was not similarly available within the region. Especially, inhabitants in the southern county experienced less access to the regional service. National and regional standards of care, new scanners and improved collaboration between hospital trusts may alter this situation.
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Affiliation(s)
- Jan Norum
- Department of Clinical Medicine, Medical Imaging Research Group, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
| | - Ursula Søndergaard
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
| | - Erik Traasdahl
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
| | - Carsten Nieder
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
- Nordland hospital, N-8017, Bodø, Norway.
| | - Geir Tollåli
- Nordland hospital, N-8017, Bodø, Norway.
- Northern Norway Regional Health Authority trust, N-8038, Bodø, Norway.
| | - Gry Andersen
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
| | - Rune Sundset
- Department of Clinical Medicine, Medical Imaging Research Group, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.
- Department of Radiology, University Hospital of North Norway, N-9038, Tromsø, Norway.
- Northern Norway Regional Health Authority trust, N-8038, Bodø, Norway.
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Dasgeb B, Morris MA, Mehregan D, Siegel EL. Quantified ultrasound elastography in the assessment of cutaneous carcinoma. Br J Radiol 2015; 88:20150344. [PMID: 26268142 DOI: 10.1259/bjr.20150344] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of high-frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study and to introduce the use of a "strain ratio" for evaluation of skin lesions. METHODS A commercial ultrasound system with a 14-MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2- to 4-mm gel stand-off pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a strain ratio of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy. RESULTS 55 patients were included in the study with a total of 67 lesions evaluated. 29 lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant. CONCLUSION This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy. ADVANCES IN KNOWLEDGE This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.
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Affiliation(s)
- Bahar Dasgeb
- 1 Department of Medicine Dermatology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.,2 Analytical and Stochastic Biomedical Physics Section, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Morris
- 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA.,4 Department of Internal Medicine, Mercy Medical Center, Baltimore, MD, USA
| | - Darius Mehregan
- 5 Department of Dermatology, Wayne State University, Dearborn, MI, USA.,6 Pinkus Dermatopathology Laboratories, Monroe, MI, USA
| | - Eliot L Siegel
- 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA.,7 Department of Diagnostic Radiology and Nuclear Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, Verzijlbergen FJ, Barrington SF, Pike LC, Weber WA, Stroobants S, Delbeke D, Donohoe KJ, Holbrook S, Graham MM, Testanera G, Hoekstra OS, Zijlstra J, Visser E, Hoekstra CJ, Pruim J, Willemsen A, Arends B, Kotzerke J, Bockisch A, Beyer T, Chiti A, Krause BJ. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015; 42:328-54. [PMID: 25452219 PMCID: PMC4315529 DOI: 10.1007/s00259-014-2961-x] [Citation(s) in RCA: 2005] [Impact Index Per Article: 222.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 12/11/2022]
Abstract
The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.
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Affiliation(s)
- Ronald Boellaard
- Department of Radiology & Nuclear Medicine, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,
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Look Hong NJ, Petrella T, Chan K. Cost-effectiveness analysis of staging strategies in patients with regionally metastatic melanoma. J Surg Oncol 2014; 111:423-30. [DOI: 10.1002/jso.23833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/08/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Nicole J. Look Hong
- Division of Surgical Oncology; Sunnybrook Health Sciences Centre; University of Toronto; Ontario Canada
| | - Teresa Petrella
- Division of Medical Oncology; Sunnybrook Health Sciences Centre; University of Toronto; Ontario Canada
| | - Kelvin Chan
- Division of Medical Oncology; Sunnybrook Health Sciences Centre; University of Toronto; Ontario Canada
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Perissinotti A, Vidal-Sicart S, Nieweg O, Valdés Olmos R. Melanoma and nuclear medicine. Melanoma Manag 2014; 1:57-74. [PMID: 30190811 DOI: 10.2217/mmt.14.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Supported by a large body of published work, the contribution of nuclear medicine technologies to the assessment of melanoma has been increasing in recent years. Lymphoscintigraphy-assisted sentinel lymph node biopsy and PET are in continuous evolution with the aid of technological imaging advances, making it possible to fuse functional and anatomic images (e.g., with SPECT/CT, PET/CT and 3D rendering systems). The development of hybrid fluorescent-radioactive tracers that enable high-quality preoperative lymphoscintigraphy and SPECT/CT, and the optimization of modern intraoperative portable imaging technologies, such as free-hand SPECT and portable γ-cameras, are important innovations that have improved sentinel lymph node identification in complex anatomical areas, such as the pelvis and head and neck. Concurrently, 18F-fluorodeoxyglucose-PET has proved its usefulness in the clinical staging and treatment decision-making process, and there is also emerging evidence regarding its utility in the evaluation of therapeutic response. The potential uses of other novel PET radiotracers could open up a new field of use for this technique. In this article, we review the current and future role of nuclear medicine in the management of melanoma.
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Affiliation(s)
- Andrés Perissinotti
- Nuclear Medicine Department, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain.,Nuclear Medicine Department, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain.,Nuclear Medicine Department, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Omgo Nieweg
- Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW 2060, Australia.,Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW 2060, Australia
| | - Renato Valdés Olmos
- Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.,Interventional Molecular Imaging Laboratory & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.,Interventional Molecular Imaging Laboratory & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Rodriguez Rivera AM, Alabbas H, Ramjaun A, Meguerditchian AN. Value of positron emission tomography scan in stage III cutaneous melanoma: A systematic review and meta-analysis. Surg Oncol 2014; 23:11-6. [DOI: 10.1016/j.suronc.2014.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/06/2014] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
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Billaud EMF, Rbah-Vidal L, Vidal A, Besse S, Tarrit S, Askienazy S, Maisonial A, Moins N, Madelmont JC, Miot-Noirault E, Chezal JM, Auzeloux P. Synthesis, Radiofluorination, and in Vivo Evaluation of Novel Fluorinated and Iodinated Radiotracers for PET Imaging and Targeted Radionuclide Therapy of Melanoma. J Med Chem 2013; 56:8455-67. [DOI: 10.1021/jm400877v] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emilie M. F. Billaud
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Latifa Rbah-Vidal
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Aurélien Vidal
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Sophie Besse
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Sébastien Tarrit
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Serge Askienazy
- Cyclopharma Laboratories, Biopôle
Clermont-Limagne, Saint-Beauzire F-63360, France
| | - Aurélie Maisonial
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Nicole Moins
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Jean-Claude Madelmont
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Elisabeth Miot-Noirault
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Jean-Michel Chezal
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
| | - Philippe Auzeloux
- Clermont Université, Université d’Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France
- Inserm, U 990, F-63000 Clermont-Ferrand, France
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40
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dos Santos CL, Fernandes LR, Meruje M, Barata F. Primary pulmonary melanoma: the unexpected tumour. BMJ Case Rep 2013; 2013:bcr-2013-200706. [PMID: 24108769 DOI: 10.1136/bcr-2013-200706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 62-year-old woman was referred to our pulmonology team with exertional dyspnoea and chest tightness of 2 months duration. Her medical history included cervical cancer and thyroid nodules. Imaging studies showed collapse of left upper lobe. Fiberoptic bronchoscopy unveiled an endoluminal lesion and bronchial biopsy displayed features of melanoma. She denied a history of melanoma or excision of lesions of skin, mucous membranes or the eye. A thorough evaluation including combined positron emission tomography with CT scan excluded other possible sites of primary melanoma, but there was a metastasis in a thoracic vertebra. Palliative radiotherapy of the spine was performed. Chemotherapy initiation with dacarbazine was postponed by the appearance of a malignant pleural effusion, confirmed by pleural fluid cytology. After four cycles chemotherapy was discontinued due to disease progression. The patient is still alive with a follow-up of 12 months, currently on best supportive care.
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Affiliation(s)
- Cláudia Lares dos Santos
- Department of Pulmonology, Centro Hospitalar e Universitário de Coimbra-Hospital Geral, Coimbra, Portugal
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Subesinghe M, Marples M, Scarsbrook AF, Smith JT. Clinical impact of (18)F-FDG PET-CT in recurrent stage III/IV melanoma: a tertiary centre Specialist Skin Cancer Multidisciplinary Team (SSMDT) experience. Insights Imaging 2013; 4:701-9. [PMID: 24018755 PMCID: PMC3781245 DOI: 10.1007/s13244-013-0285-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/09/2013] [Accepted: 08/26/2013] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess the clinical impact of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) compared with contrast-enhanced computed tomography (CECT) in patients referred via the Specialist Skin Cancer Multidisciplinary Team (SSMDT) with recurrent stage III/IV malignant melanoma (MM). Methods Forty-five patients were referred for further evaluation with FDG PET-CT. Findings on FDG PET-CT were compared with prior CECT and the clinical impact on subsequent management decisions was determined retrospectively. A major clinical impact was defined as a change in treatment plan resulting from identification of additional sites of disease or by characterisation of indeterminate findings on prior imaging. A minor impact was defined as confirmation of known sites of disease as identified on prior CECT. Results Fifty-one PET-CT examinations were performed. FDG PET-CT had a major clinical impact in 21 cases (41.2 %), of which 18 examinations were performed in patients with proven or suspected stage IV MM. FDG PET-CT had a minor impact in 23 cases (45.1 %), and there were five false-positive cases (9.8 %) and two false-negative cases (3.9 %). Conclusion FDG PET-CT is an effective tool in recurrent stage III/IV MM with a significant clinical impact on management decisions in patients who are appropriately referred via the highly specialised forum of the SSMDT. Key Points • FDG PET-CT is an effective tool in recurrent stage III/IV malignant melanoma. • FDG PET-CT has a significant clinical impact on management decisions. • Effective use of FDG PET-CT is via referral from the Specialist Skin Cancer Multidisciplinary Team.
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Affiliation(s)
- Manil Subesinghe
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK,
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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 2013; 36:1313-6. [PMID: 23956077 DOI: 10.1002/hed.23456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 05/15/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fluorodeoxyglucose-positron emission tomography (FDG-PET) has a high sensitivity for detecting metastasis from melanoma, but its application in early-stage melanomas is questionable. The purpose of this study was to determine if positron emission tomography (PET) is beneficial in staging of clinically node negative (cN0) head and neck melanoma. METHODS After institutional review board approval, patients with head and neck melanoma treated at 2 cancer centers (between 2000 and 2010) were identified using International Classification of Disease (ICD)-9 codes. A retrospective medical chart review of cN0 patients was performed for the treatment course and outcomes. RESULTS A total of 165 patients were treated; of these, 106 were node negative. FDG-PET was included in initial staging of 47 cN0 patients. None had true distant metastasis detected on PET. The imaging also failed to detect nodal metastasis in 2 patients who had disease on lymphatic sampling. CONCLUSION FDG-PET did not alter the initial staging or treatment in patients with cN0 head and neck melanoma. Therefore, its routine use for staging is not warranted.
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Affiliation(s)
- Jai Bikhchandani
- Department of Surgery, Creighton University Medical Center, Omaha, Nebraska
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Schröer-Günther MA, Wolff RF, Westwood ME, Scheibler FJ, Schürmann C, Baumert BG, Sauerland S, Kleijnen J. F-18-fluoro-2-deoxyglucose positron emission tomography (PET) and PET/computed tomography imaging in primary staging of patients with malignant melanoma: a systematic review. Syst Rev 2012; 1:62. [PMID: 23237499 PMCID: PMC3536719 DOI: 10.1186/2046-4053-1-62] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 11/16/2012] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED PURPOSE The aim of this systematic review was to systematically assess the potential patient-relevant benefit (primary aim) and diagnostic and prognostic accuracy (secondary aim) of positron emission tomography (PET) and PET/computed tomography (CT) in primary staging of malignant melanoma. This systematic review updates the previous evidence for PET(/CT) in malignant melanoma. MATERIALS AND METHODS For the first aim, randomized controlled trials (RCTs) investigating patient-relevant outcomes and comparing PET and PET(/CT) with each other or with conventional imaging were considered. For the secondary aim, a review of reviews was conducted, which was amended by an update search for primary studies. MEDLINE, EMBASE and four databases of the Cochrane Library were searched. The risk of bias was assessed using a modified QUADAS tool. RESULTS No RCTs investigating the patient-relevant benefit of PET(/CT) and no prognostic accuracy studies were found. Seventeen diagnostic accuracy studies of varying quality were identified. For patients with American Joint Committee on Cancer (AJCC) stages I and II, sensitivity mostly ranged from 0 to 67%. Specificity ranged from 77 to 100%. For AJCC stages III and IV, sensitivity ranged from 68 to 87% and specificity from 92 to 98%. CONCLUSION There is currently no evidence of a patient-relevant benefit of PET(/CT) in the primary staging of malignant melanoma. RCTs investigating patient-relevant outcomes are therefore required. The diagnostic accuracy of PET(/CT) appears to increase with higher AJCC stages.
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Affiliation(s)
- Milly A Schröer-Günther
- Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne, 50670, Germany
| | - Robert F Wolff
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park Riccall Road, Escrick, York, YO19 6FD, UK
| | - Marie E Westwood
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park Riccall Road, Escrick, York, YO19 6FD, UK
| | - Fülöp J Scheibler
- Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne, 50670, Germany
| | - Christoph Schürmann
- Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne, 50670, Germany
| | - Brigitta G Baumert
- Department of Radiation–Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Center, P.O. Box 616, Maastricht, MD, 6200, the Netherlands
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne, 50670, Germany
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park Riccall Road, Escrick, York, YO19 6FD, UK
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht, ER, 6229, the Netherlands
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Ortega Candil A, Rodríguez Rey C, Carreras Delgado JL. Malignant melanoma. ISRN DERMATOLOGY 2012; 2012:308279. [PMID: 23259071 PMCID: PMC3521489 DOI: 10.5402/2012/308279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022]
Abstract
Nuclear medicine plays an essential role in the correct staging of patients suffering from melanoma. Both sentinel lymph node biopsy (SLNB) and positron emission tomography (PET) represent its main diagnostic tools. SLNB is the choice procedure for lymphatic regional staging of these patients, including the result of this technique in the 2002 American Joint Cancer Committee melanoma staging. SLNB sensitivity is superior than PET/CT for the detection of lymphatic micrometastases in early stages of the disease. PET/CT is mainly used in confirming clinical metastases suspected, detection of recurrences, and recurrence restaging. PET/CT has also shown superiority against conventional diagnostic methods in the detection of distant metastases, being able to detect illness even six months earlier than those methods.
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Affiliation(s)
- Aída Ortega Candil
- Department of Nuclear Medicine, Clinico San Carlos Hospital, 28040 Madrid, Spain
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Diffuse cutaneous uptake of 18F-flurodeoxyglucose is associated with adverse prognosis in patients with melanoma. Nucl Med Commun 2012. [DOI: 10.1097/mnm.0b013e328358d9e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rbah-Vidal L, Vidal A, Besse S, Cachin F, Bonnet M, Audin L, Askienazy S, Dollé F, Degoul F, Miot-Noirault E, Moins N, Auzeloux P, Chezal JM. Early detection and longitudinal monitoring of experimental primary and disseminated melanoma using [18F]ICF01006, a highly promising melanoma PET tracer. Eur J Nucl Med Mol Imaging 2012; 39:1449-61. [PMID: 22707183 DOI: 10.1007/s00259-012-2168-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/22/2012] [Indexed: 01/10/2023]
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47
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Quaglino P, Ribero S, Osella-Abate S, Macrì L, Grassi M, Caliendo V, Asioli S, Sapino A, Macripò G, Savoia P, Bernengo M. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study. Surg Oncol 2011; 20:259-64. [DOI: 10.1016/j.suronc.2010.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/04/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
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Uren RF, Howman-Giles R, Chung D, Thompson JF. Guidelines for lymphoscintigraphy and F18 FDG PET scans in melanoma. J Surg Oncol 2011; 104:405-19. [PMID: 21858836 DOI: 10.1002/jso.21770] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Melanoma has a high potential to develop metastases. Accurate staging is essential for appropriate management. Sentinel node (SN) status is a powerful prognostic factor in early stage melanoma. Staging is assisted by SN biopsy after lymphoscintigraphy to locate all true SNs prior to biopsy. PET using F18-FDG can detect metastases and is used to restage patients with AJCC Stages III and IV disease before planning surgery with curative intent.
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Affiliation(s)
- Roger F Uren
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Abstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides a functional or metabolic assessment of normal tissue or disease conditions. Fluorine 18-fluorodeoxyglucose PET imaging (FDG-PET) is widely used clinically for tumor imaging due to increased glucose metabolism in most types of tumors, and has been shown to improve the diagnosis and subsequent treatment of cancers. We review its use in cancer diagnosis, staging, restaging, and assessment of response to treatment. In addition, other metabolic PET imaging agents in pre-clinical research or clinical trial stages of development are discussed, including amino acid analogs based on increased protein synthesis, and choline, which is based on increased membrane lipid synthesis. Amino acid analogs and choline are more specific to tumor cells than FDG, so they play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with low FDG uptake or high background FDG uptake. For decades, researchers have shown that tumors display altered metabolic profiles with elevated uptake of glucose, amino acids, and lipids. This can be used for cancer diagnosis and monitoring of the therapeutic response with excellent signal-to-noise ratios.
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Affiliation(s)
- Aizhi Zhu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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Maisonial A, Kuhnast B, Papon J, Boisgard R, Bayle M, Vidal A, Auzeloux P, Rbah L, Bonnet-Duquennoy M, Miot-Noirault E, Galmier MJ, Borel M, Askienazy S, Dollé F, Tavitian B, Madelmont JC, Moins N, Chezal JM. Single photon emission computed tomography/positron emission tomography imaging and targeted radionuclide therapy of melanoma: new multimodal fluorinated and iodinated radiotracers. J Med Chem 2011; 54:2745-66. [PMID: 21417462 DOI: 10.1021/jm101574q] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study reports a series of 14 new iodinated and fluorinated compounds offering both early imaging ((123)I, (124)I, (18)F) and systemic treatment ((131)I) of melanoma potentialities. The biodistribution of each (125)I-labeled tracer was evaluated in a model of melanoma B16F0-bearing mice, using in vivo serial γ scintigraphic imaging. Among this series, [(125)I]56 emerged as the most promising compound in terms of specific tumoral uptake and in vivo kinetic profile. To validate our multimodality concept, the radiosynthesis of [(18)F]56 was then optimized and this radiotracer has been successfully investigated for in vivo PET imaging of melanoma in B16F0- and B16F10-bearing mouse model. The therapeutic efficacy of [(131)I]56 was then evaluated in mice bearing subcutaneous B16F0 melanoma, and a significant slow down in tumoral growth was demonstrated. These data support further development of 56 for PET imaging ((18)F, (124)I) and targeted radionuclide therapy ((131)I) of melanoma using a single chemical structure.
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Affiliation(s)
- Aurélie Maisonial
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, Clermont-Ferrand, France
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