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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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Johnston L, Starkey S, Mukovozov I, Robertson L, Petrella T, Alhusayen R. Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines. J Cutan Med Surg 2023; 27:516-525. [PMID: 37489919 PMCID: PMC10617001 DOI: 10.1177/12034754231188434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Cutaneous melanoma accounts for more than 70% of all skin cancer deaths. Follow-up surveillance is an integral part of melanoma patient care, to facilitate early detection of recurrences and subsequent primary melanomas. The purpose of this scoping review is to provide an overview of recently published melanoma surveillance guidelines from regional and national melanoma working groups. METHODS A systematic search for relevant studies in MEDLINE and Embase was conducted in September 2022 and was limited to publications from 2010 or later. RESULTS A total of 1047 articles were retrieved, and after abstract and full text review, 26 articles from 19 different organizations met inclusion criteria. Life-long annual skin surveillance with a physician was recommended by 53% (9/17) of guidelines. Routine laboratory investigations were recommended by 7/19 guidelines. Regional lymph node ultrasound was recommended by 9/16 guidelines, most often in stage IB or higher, and was optional in 7/16 for patients who met specific criteria. Surveillance with PET-CT or CT and MRI was recommended by 15 and 11 guidelines, respectively, most commonly in stage IIC or higher, with a variable frequency and total duration. Five out of 9 guidelines indicated a preference for skin surveillance to be completed with a dermatologist. CONCLUSION Guidelines were highly variable for many aspects of melanoma surveillance, which may be partly attributed to regional differences in healthcare workforce distribution and availability of imaging technologies. Further high-level studies are recommended to provide more evidence on the most effective clinical and imaging follow-up surveillance protocols.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samantha Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Lynne Robertson
- Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Teresa Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, Canada
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Canada
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Yan MK, Adler NR, Wolfe R, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. The role of surveillance imaging for resected high‐risk melanoma. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mabel K. Yan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Nikki R. Adler
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Yan Pan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - John Kelly
- Victorian Melanoma Service Alfred Health Melbourne Australia
| | - Kenneth Yap
- Central Clinical School Monash University Melbourne Australia
- Department of Nuclear Medicine and PET Alfred Health Melbourne Australia
| | - Mark Voskoboynik
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Andrew Haydon
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Mark Shackleton
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Victoria J. Mar
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
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Dieng M, Turner RM, Lord SJ, Einstein AJ, Menzies AM, Saw RPM, Nieweg OE, Thompson JF, Morton RL. Cost-Effectiveness of PET/CT Surveillance Schedules to Detect Distant Recurrence of Resected Stage III Melanoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042331. [PMID: 35206519 PMCID: PMC8872338 DOI: 10.3390/ijerph19042331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
Objective: To estimate the cost-effectiveness of three surveillance imaging strategies using whole-body positron emission tomography (PET) with computed tomography (CT) (PET/CT) in a follow-up program for adults with resected stage III melanoma. Methods: An analytic decision model was constructed to estimate the costs and benefits of PET/CT surveillance imaging performed 3-monthly, 6-monthly, or 12-monthly compared with no surveillance imaging. Results: At 5 years, 3-monthly PET/CT surveillance imaging incurred a total cost of AUD 88,387 per patient, versus AUD 77,998 for 6-monthly, AUD 52,560 for 12-monthly imaging, and AUD 51,149 for no surveillance imaging. When compared with no surveillance imaging, 12-monthly PET/CT imaging was associated with a 4% increase in correctly diagnosed and treated distant disease; a 0.5% increase with 6-monthly imaging and 1% increase with 3-monthly imaging. The incremental cost-effectiveness ratio (ICER) of 12-monthly PET/CT surveillance imaging was AUD 34,362 for each additional distant recurrence correctly diagnosed and treated, compared with no surveillance imaging. For the outcome of cost per diagnostic error avoided, the no surveillance imaging strategy was the least costly and most effective. Conclusion: With the ICER for this strategy less than AUD 50,000 per unit of health benefit, the 12-monthly surveillance imaging strategy is considered good value for money.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
- Correspondence:
| | - Robin M. Turner
- Biostatistics Centre, Otago University, Dunedin 9016, New Zealand;
| | - Sarah J. Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
| | - Andrew J. Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY 10032, USA;
| | - Alexander M. Menzies
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, North Sydney 2060, Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Omgo E. Nieweg
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - John F. Thompson
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
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Dieng M, Lord SJ, Nieweg OE, Saw RPM, Einstein AJ, Nijhuis AAG, Turner RM, Thompson JF, Morton RL. Reply to: CT and PET/CT Surveillance in Stage IIIA-D Melanoma Results in More False-Positive Than True-Positive Findings and Should Not be Routinely Recommended, by Nicholas Taylor et al. Ann Surg Oncol 2021; 28:819-820. [PMID: 33937972 DOI: 10.1245/s10434-021-09821-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia. .,School of Public Health, The University of Sydney, Camperdown, Australia.
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, Wollstonecraft, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, Wollstonecraft, Australia
| | - Andrew J Einstein
- Department of Medicine, Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, USA.,Department of Radiology, Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | | | - Robin M Turner
- Biostatistics, University of Otago, Dunedin, New Zealand
| | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
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Taylor NA, Brodland DG. CT and PET-CT Surveillance in Stages 3A to 3D Melanoma Results in More False-Positive than True-Positive Findings and Should Not be Routinely Recommended. Ann Surg Oncol 2021; 28:817-818. [PMID: 33738714 DOI: 10.1245/s10434-021-09820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/18/2022]
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Whole-Body MRI for the Detection of Recurrence in Melanoma Patients at High Risk of Relapse. Cancers (Basel) 2021; 13:cancers13030442. [PMID: 33503861 PMCID: PMC7865287 DOI: 10.3390/cancers13030442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: No standard protocol for surveillance for melanoma patients is established. Whole-body magnetic resonance imaging (whole-body MRI) is a safe and sensitive technique that avoids exposure to X-rays and contrast agents. This prospective study explores the use of whole-body MRI for the early detection of recurrences. Material and Methods: Patients with American Joint Committee on Cancer Staging Manual (seventh edition; AJCC-7) stages IIIb/c or -IV melanoma who were disease-free following resection of macrometastases (cohort A), or obtained a durable complete response (CR) or partial response (PR) following systemic therapy (cohort B), were included. All patients underwent whole-body MRI, including T1, Short Tau Inversion Recovery, and diffusion-weighted imaging, every 4 months the first 3 years of follow-up and every 6 months in the following 2 years. A total body skin examination was performed every 6 months. Results: From November 2014 to November 2019, 111 patients were included (four screen failures, cohort A: 68 patients; cohort B: 39 patients). The median follow-up was 32 months. Twenty-six patients were diagnosed with suspected lesions. Of these, 15 patients were diagnosed with a recurrence on MRI. Eleven suspected lesions were considered to be of non-neoplastic origin. In addition, nine patients detected a solitary subcutaneous metastasis during self-examination, and two patients presented in between MRIs with recurrences. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 58%, 98%, 58%, 98%, and 98%. Sensitivity and specificity for the detection of distant metastases was respectively 88% and 98%. No patient experienced a clinically meaningful (>grade 1) adverse event. Conclusions: Whole-body MRI for the surveillance of melanoma patients is a safe and sensitive technique sparing patients' cumulative exposure to X-rays and contrast media.
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Dieng M, Morton RL. ASO Author Reflections: Longitudinal Diagnostic Accuracy of Surveillance Imaging in Resected Stage III Melanoma Patients. Ann Surg Oncol 2021; 28:4570-4571. [PMID: 33389289 DOI: 10.1245/s10434-020-09407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Dieng M, Khanna N, Nguyen MTH, Turner R, Lord SJ, Menzies AM, Allen J, Saw R, Nieweg OE, Thompson J, Morton RL. Cost-effectiveness analysis of PET/CT surveillance imaging to detect systemic recurrence in resected stage III melanoma: study protocol. BMJ Open 2020; 10:e037857. [PMID: 33154047 PMCID: PMC7646332 DOI: 10.1136/bmjopen-2020-037857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the new era of effective systemic therapies for advanced melanoma, early detection of lower volume recurrent disease using surveillance imaging can improve survival. However, intensive imaging follow-up strategies are likely to increase costs to health systems and may pose risks to patients. The objective of this study is to estimate from the Australian health system perspective the cost-effectiveness of four follow-up strategies in resected stage III melanoma over a 5-year period following surgical treatment with curative intent. METHODS AND ANALYSIS A decision-analytic model will be built to estimate the costs and benefits of (1) 12 monthly, (2) 6 monthly, (3) 3-4 monthly positron emission tomography/CT imaging for 5 years, compared with (4) no imaging follow-up. The model will be populated with probabilities of disease recurrence, test performance measures using data from >1000 consecutive resected stage III melanoma patients from Melanoma Institute Australia diagnosed between 2000 and 2017. Healthcare resource use, including surveillance imaging, doctor's visits, subsequent tests and procedures to investigate suspicious findings, will be quantified from detailed patient records and valued using Australian reference pricing. Economic outcomes include cost per new distant melanoma recurrence detected and cost per diagnostic error avoided, for no imaging compared with the other strategies.Deterministic sensitivity analyses will examine the robustness of model results. ETHICS AND DISSEMINATION This study was approved by the Sydney Local Health District, Sydney Local Health District Ethics Review Committee (RPAH Zone), AU/1/830638 and the Australian Institute of Health and Welfare (EO2019-1-454). The results of this study will be published in peer-reviewed medical and health economics journals and will inform melanoma management guidelines.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nikita Khanna
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mai Thi Hoang Nguyen
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Robin Turner
- Biostatistics, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Jay Allen
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Robyn Saw
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Thompson
- Surgical Oncology, Melanoma Institute of Australia, North Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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