Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy

Jeffrey D. Wagner, Donald Schauwecker, Darrell Davidson, John J. Coleman, Scott Saxman, Gary Hutchins, Charlene Love, John T. Hayes

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

Purpose: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. Methods: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4NOMO) or localized regional cutaneous recurrence (TxN2bMO) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. Results: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. Conclusion: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG- PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

Original languageEnglish
Pages (from-to)1508-1515
Number of pages8
JournalJournal of Clinical Oncology
Volume17
Issue number5
StatePublished - 1999

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Positron-Emission Tomography
Melanoma
Lymph Nodes
Prospective Studies
Biopsy
Tumor Burden
Neoplasm Metastasis
Skin
cyhalothrin
Whole Body Imaging
Recurrence
Neoplasms
Glucose
Population

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. / Wagner, Jeffrey D.; Schauwecker, Donald; Davidson, Darrell; Coleman, John J.; Saxman, Scott; Hutchins, Gary; Love, Charlene; Hayes, John T.

In: Journal of Clinical Oncology, Vol. 17, No. 5, 1999, p. 1508-1515.

Research output: Contribution to journalArticle

Wagner, Jeffrey D. ; Schauwecker, Donald ; Davidson, Darrell ; Coleman, John J. ; Saxman, Scott ; Hutchins, Gary ; Love, Charlene ; Hayes, John T. / Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 5. pp. 1508-1515.
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abstract = "Purpose: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. Methods: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4NOMO) or localized regional cutaneous recurrence (TxN2bMO) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. Results: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7{\%}) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3{\%}) and one by follow-up examination (1.4{\%}). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4{\%}, specificity was 100{\%}, positive predictive value (PPV) was 100{\%}, and negative predictive value (NPV) was 98.6{\%}. Sensitivity of FDG-PET was 16.7{\%}, specificity was 95.8{\%}, PPV was 50{\%}, and NPV was 81.9{\%}. At a median follow-up duration of 16.6 months, seven patients (10{\%}) developed recurrent disease. PET predicted one recurrence (14.3{\%}) in a node basin missed by SNB. Conclusion: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG- PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.",
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T1 - Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy

AU - Wagner, Jeffrey D.

AU - Schauwecker, Donald

AU - Davidson, Darrell

AU - Coleman, John J.

AU - Saxman, Scott

AU - Hutchins, Gary

AU - Love, Charlene

AU - Hayes, John T.

PY - 1999

Y1 - 1999

N2 - Purpose: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. Methods: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4NOMO) or localized regional cutaneous recurrence (TxN2bMO) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. Results: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. Conclusion: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG- PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

AB - Purpose: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. Methods: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4NOMO) or localized regional cutaneous recurrence (TxN2bMO) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. Results: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. Conclusion: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG- PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

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