Can integrated 18F-FDG PET/MR replace sentinel lymph node resection in malignant melanoma?
- 187 Downloads
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.
KeywordsPET/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.
- 9.Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. Ann Surg Oncol. 2018;25:356–77.CrossRefPubMedCentralGoogle Scholar
- 14.Oude Ophuis CMC, Koppert L (Linetta) B, de Monyé C, van Deurzen CHM, Koljenović S, van Akkooi ACJ, et al. Gamma probe and ultrasound guided fine needle aspiration cytology of the sentinel node (GULF) trial - overview of the literature, pilot and study protocol. BMC Cancer [Internet]. 2017 [cited 2017 Oct 30];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389093/.
- 21.van Nijnatten TJA, Goorts B, Vöö S, de Boer M, Kooreman LFS, Heuts EM, et al. Added value of dedicated axillary hybrid 18F-FDG PET/MRI for improved axillary nodal staging in clinically node-positive breast cancer patients: a feasibility study. Eur J Nucl Med Mol Imaging. 2017:1–8.Google Scholar
- 22.Grueneisen J, Beiderwellen K, Heusch P, Buderath P, Aktas B, Gratz M, et al. Correlation of standardized uptake value and apparent diffusion coefficient in integrated whole-body PET/MRI of primary and recurrent cervical cancer. PLoS One [Internet]. 2014 [cited 2017 Sep 6];9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013042/.
- 23.Schaarschmidt BM, Buchbender C, Nensa F, Grueneien J, Gomez B, Köhler J, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in lymph node metastases of non-small cell lung cancer (NSCLC) patients using hybrid 18F-FDG PET/MRI. PLoS One [Internet]. 2015 [cited 2017 Aug 7];10. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289066/.
- 26.Stoffels I, Dissemond J, Körber A, Hillen U, Poeppel T, Schadendorf D, et al. Reliability and cost-effectiveness of sentinel lymph node excision under local anaesthesia versus general anaesthesia for malignant melanoma: a retrospective analysis in 300 patients with malignant melanoma AJCC stages I and II. J Eur Acad Dermatol Venereol. 2011;25:306–10.CrossRefPubMedCentralGoogle Scholar
- 35.Fink AM, Holle-Robatsch S, Herzog N, Mirzaei S, Rappersberger K, Lilgenau N, et al. Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II. Melanoma Res. 2004;14:141–5.CrossRefPubMedCentralGoogle Scholar