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

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

Abstract

Purpose

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.

Results

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.

Conclusion

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.

Keywords

PET/MRI PET/CT MRI Malignant melanoma MM DWI 

Notes

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)

References

  1. 1.
    Morton DL, Wanek L, Nizze JA, Elashoff RM, Wong JH. Improved long-term survival after lymphadenectomy of melanoma metastatic to regional nodes. Analysis of prognostic factors in 1134 patients from the John Wayne Cancer Clinic. Ann Surg. 1991;214:491–501.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Balch CM, Soong S-J, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American joint committee on Cancer melanoma staging system. JCO. 2001;19:3622–34.CrossRefGoogle Scholar
  3. 3.
    Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early-stage melanoma. Ann Surg. 2005;242:302–13.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.CrossRefGoogle Scholar
  5. 5.
    van der Ploeg APT, van Akkooi ACJ, Rutkowski P, Nowecki ZI, Michej W, Mitra A, et al. Prognosis in patients with sentinel node–positive melanoma is accurately defined by the combined Rotterdam tumor load and Dewar topography criteria. JCO. 2011;29:2206–14.CrossRefGoogle Scholar
  6. 6.
    Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599–609.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline. Eur J Cancer. 2010;46:270–83.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, et al. S3-guideline “diagnosis, therapy and follow-up of melanoma” – short version. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2013;11:563–602.PubMedPubMedCentralGoogle Scholar
  9. 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
  10. 10.
    Nieweg OE, Veenstra HJ. False-negative sentinel node biopsy in melanoma. J Surg Oncol. 2011;104:709–10.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Veenstra HJ, Wouters MJWM, Kroon BBR, Olmos RAV, Nieweg OE. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol. 2011;104:454–7.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Antoch G, Vogt FM, Freudenberg LS, Nazaradeh F, Goehde SC, Barkhausen J, et al. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA. 2003;290:3199–206.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33.CrossRefPubMedCentralGoogle Scholar
  14. 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/.
  15. 15.
    El-Maraghi RH, Kielar AZ. PET vs sentinel lymph node biopsy for staging melanoma: a patient intervention, comparison, outcome analysis. J Am Coll Radiol. 2008;5:924–31.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Singh B, Ezziddin S, Palmedo H, Reinhardt M, Strunk H, Tüting T, et al. Preoperative 18F-FDG-PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma. Melanoma Res. 2008;18:346–52.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Scheier BY, Lao CD, Kidwell KM, Redman BG. Use of preoperative PET/CT staging in sentinel lymph node–positive melanoma. JAMA Oncol. 2016;2:136–7.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Riegger C, Koeninger A, Hartung V, Otterbach F, Kimmig R, Forsting M, et al. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast Cancer patients. Acta Radiol. 2012;53:1092–8.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Scaranelo AM, Eiada R, Jacks LM, Kulkarni SR, Crystal P. Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis: study of reproducibility and reliability. Radiology. 2012;262:425–34.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Schipper R-J, Paiman M-L, Beets-Tan RGH, Nelemans PJ, de Vries B, Heuts EM, et al. Diagnostic performance of dedicated axillary T2- and diffusion-weighted MR imaging for nodal staging in breast cancer. Radiology. 2015;275:345–55.CrossRefPubMedCentralGoogle Scholar
  21. 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. 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. 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/.
  24. 24.
    Stoffels I, Boy C, Pöppel T, Kuhn J, Klötgen K, Dissemond J, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA. 2012;308:1007–14.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U, et al. Evidence-based and interdisciplinary consensus-based German guidelines: systemic medical treatment of melanoma in the adjuvant and palliative setting. Melanoma Res. 2008;18:152–60.CrossRefPubMedCentralGoogle Scholar
  26. 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
  27. 27.
    Klode J, Poeppel T, Boy C, Mueller S, Schadendorf D, Körber A, et al. Advantages of preoperative hybrid SPECT/CT in detection of sentinel lymph nodes in cutaneous head and neck malignancies. J Eur Acad Dermatol Venereol. 2011;25:1213–21.CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Barthelmes L, Goyal A, Newcombe RG, McNeill F, Mansel RE. Adverse reactions to patent blue V dye – the NEW START and ALMANAC experience. European Journal of Surgical Oncology (EJSO). 2010;36:399–403.CrossRefGoogle Scholar
  29. 29.
    van Akkooi ACJ, de Wilt JHW, Verhoef C, Schmitz PIM, van Geel AN, Eggermont AMM, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol. 2006;17:1578–85.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Hinz T, Voth H, Ahmadzadehfar H, Hoeller T, Wenzel J, Bieber T, et al. Role of high-resolution ultrasound and PET/CT imaging for preoperative characterization of sentinel lymph nodes in cutaneous melanoma. Ultrasound Med Biol. 2013;39:30–6.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Stoffels I, Morscher S, Helfrich I, Hillen U, Leyh J, Burton NC, et al. Metastatic status of sentinel lymph nodes in melanoma determined noninvasively with multispectral optoacoustic imaging. Sci Transl Med. 2015;7:317ra199.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Gritters LS, Francis IR, Zasadny KR, Wahl RL. Initial assessment of positron emission tomography using 2-Fluorine-18-Fluoro-2-deoxy-D-glucose in the imaging of malignant melanoma. J Nucl Med. 1993;34:1420–7.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Steinert HC, Huch Böni RA, Buck A, Böni R, Berthold T, Marincek B, et al. Malignant melanoma: staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology. 1995;195:705–9.CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Wagner JD, Schauwecker DS, Davidson D, Wenck S, Jung S-H, Hutchins G. FDG–PET sensitivity for melanoma lymph node metastases is dependent on tumor volume. J Surg Oncol. 2001;77:237–42.CrossRefPubMedCentralGoogle Scholar
  35. 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
  36. 36.
    Hafner J, Schmid MH, Kempf W, Burg G, Künzi W, Meuli-Simmen C, et al. Baseline staging in cutaneous malignant melanoma. Br J Dermatol. 2004;150:677–86.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Wagner JD, Schauwecker D, Davidson D, Logan T, Coleman JJ, Hutchins G, et al. Inefficacy of F-18 fluorodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early-stage cutaneous melanoma. Cancer. 2005;104:570–9.CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Clark PB, Soo V, Kraas J, Shen P, Levine EA. Futility of Fluorodeoxyglucose F 18 positron emission tomography in initial evaluation of patients with T2 to T4 melanoma. Arch Surg. 2006;141:284–8.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Lockau HH, Neuschmelting V, Ogirala A, Vilaseca A, Grimm J. Dynamic 18F-FDG PET- Lymphography for in vivo identification of lymph node metastases in murine melanoma. J Nucl Med. 2017;  https://doi.org/10.2967/jnumed.117.196303.CrossRefPubMedCentralGoogle Scholar
  40. 40.
    Coit DG, Thompson JA, Algazi A, Andtbacka R, Bichakjian CK, Carson WE, et al. Melanoma, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2016;14:450–73.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Benedikt Michael Schaarschmidt
    • 1
  • 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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