Can integrated 18F-FDG PET/MR replace sentinel lymph node resection in malignant melanoma?

  • Benedikt Michael SchaarschmidtEmail author
  • Johannes Grueneisen
  • Vanessa Stebner
  • Joachim Klode
  • Ingo Stoffels
  • Lale Umutlu
  • Dirk Schadendorf
  • Philipp Heusch
  • Gerald Antoch
  • Thorsten Dirk Pöppel
Original Article



To compare the sensitivity and specificity of 18F-fluordesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), 18F-FDG PET/magnetic resonance (18F-FDG PET/MR) and 18F-FDG PET/MR including diffusion weighted imaging (DWI) in the detection of sentinel lymph node metastases in patients suffering from malignant melanoma.

Material & Methods

Fifty-two patients with malignant melanoma (female: n = 30, male: n = 22, mean age 50.5 ± 16.0 years, mean tumor thickness 2.28 ± 1.97 mm) who underwent 18F-FDG PET/CT and subsequent PET/MR & DWI for distant metastasis staging were included in this retrospective study. After hybrid imaging, lymphoscintigraphy including single photon emission computed tomography/CT (SPECT/CT) was performed to identify the sentinel lymph node prior to sentinel lymph node biopsy (SLNB). In a total of 87 sentinel lymph nodes in 64 lymph node basins visible on SPECT/CT, 17 lymph node metastases were detected by histopathology. In separate sessions PET/CT, PET/MR, and PET/MR & DWI were assessed for sentinel lymph node metastases by two independent readers. Discrepant results were resolved in a consensus reading. Sensitivities, specificities, positive predictive values and negative predictive values were calculated with histopathology following SPECT/CT guided SLNB as a reference standard.


Compared with histopathology, lymph nodes were true positive in three cases, true negative in 65 cases, false positive in three cases and false negative in 14 cases in PET/CT. PET/MR was true positive in four cases, true negative in 63 cases, false positive in two cases and false negative in 13 cases. Hence, we observed a sensitivity, specificity, positive predictive value and negative predictive value of 17.7, 95.6, 50.0 and 82.3% for PET/CT and 23.5, 96.9, 66.7 and 82.3% for PET/MR. In DWI, 56 sentinel lymph node basins could be analyzed. Here, the additional analysis of DWI led to two additional false positive findings, while the number of true positive findings could not be increased.


In conclusion, integrated 18F-FDG PET/MR does not reliably differentiate N-positive from N-negative melanoma patients. Additional DWI does not increase the sensitivity of 18F-FDG PET/MR. Hence, sentinel lymph node biopsy cannot be replaced by 18F-FDG-PE/MR or 18F-FDG-PET/CT.


PET/MRI PET/CT MRI Malignant melanoma MM DWI 


Compliance with ethical standards

Benedikt M. Schaarschmidt is a stockholder for Bayer AG, General Electric, Siemens AG, Siemencs Healthineers AG, TEVA Pharmaceuticals. All other authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Supplementary material

259_2018_4061_MOESM1_ESM.xlsx (9 kb)
ESM 1 (XLSX 8 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Benedikt Michael Schaarschmidt
    • 1
    Email author
  • Johannes Grueneisen
    • 2
  • Vanessa Stebner
    • 3
  • Joachim Klode
    • 4
    • 5
    • 6
  • Ingo Stoffels
    • 4
    • 5
    • 6
  • Lale Umutlu
    • 2
  • Dirk Schadendorf
    • 4
    • 5
    • 6
  • Philipp Heusch
    • 1
  • Gerald Antoch
    • 1
  • Thorsten Dirk Pöppel
    • 3
  1. 1.Medical Faculty, Department of Diagnostic and Interventional RadiologyUniv DusseldorfDusseldorfGermany
  2. 2.Medical Faculty, Department of Diagnostic and Interventional Radiology and NeuroradiologyUniv Duisburg-EssenEssenGermany
  3. 3.Medical Faculty, Department of Nuclear MedicineUniv Duisburg-EssenEssenGermany
  4. 4.Department of Dermatology, Venerology and AllergologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  5. 5.West German Cancer CenterUniversity Duisburg-EssenEssenGermany
  6. 6.German Cancer Consortium (DKTK)HeidelbergGermany

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