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Nuklearmedizin 2011; 50(03): 116-121
DOI: 10.3413/Nukmed-0356-10-09
Original article
Schattauer GmbH

Can 18F-FDG PET/CT predict recurrence in patients with cutaneous malignant melanoma?

Kann bei Patienten mit malignem Melanom der Haut mit der 18F-FDG PET/CT ein Rezidiv vorher - gesagt werden?
S Kang
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
B.-C Ahn
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
C.M Hong
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
B.-I Song
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
H.J Lee
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
S.Y Jeong
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
S.-W Lee
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
J Lee
1   Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
,
S.J Lee
2   Department of Dermatology, Kyungpook National University School of Medicine, Daegu, South Korea
› Author Affiliations
Further Information

Publication History

received: 30 September 2010

accepted in revised form: 06 January 2010

Publication Date:
28 December 2017 (online)

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Summary

The aim of this study was to evaluate the prognostic significance of maximum standardized uptake value (SUVmax) of primary cutaneous malignant melanoma (CMM) lesions by 18F-FDG positron emission tomography/ computerized tomography (PET/ CT) in terms of recurrence. Patients, methods: 37 CMM patients (17 men, mean age: 61.7 ± 13.6 years) that underwent PET/CT at presentation were enrolled in this study. Recurrence was determined by histological confirmation or by radiological and clinical follow- up for at least 8 months after curative surgery. Clinical variables such as age, sex, clinical stage, and primary lesion location, thickness, and ulceration, and SUVmax values were analyzed with respect to their usefulness for predicting recurrence. Results: SUVmax was found to be significantly higher in patients with ulceration of primary lesion of CMM (p = 0.004) and in patients with a stage ≥ III (p < 0.000). Patients that experience recurrence had a significantly higher mean SUVmax value (4.9 ± 2.9) than patients who did not (2.1 ± 1.5, p = 0.024). ROC analysis showed that a SUVmax cut-off value 2.2 had high sensitivity (88.9%) and specificity (67.9%) for predicting recurrence. Kaplan-Meier analysis identified ulceration of primary lesion (p = 0.034), stage ≥ III (p = 0.019) and SUVmax ≥ 2.2 (p = 0.002) as predictors of recurrence. However, Cox proportional-hazards analysis showed that only SUVmax (p = 0.025, relative risk 11.063) significantly predicted recurrence. Conclusion: Preoperative SUVmax of primary lesion was found to be the most potent predictor of recurrence in CMM patient. Patients with high SUV max of primary lesion should be followed meticulously for recurrence.

Zusammenfassung

Ziel dieser Studie war die Beurteilung der prognostischen Aussagekraft des maximalen standardisierten Aufnahmewertes (SUVmax) in Primärtumoren eines kutanen malignen Melanoms (CMM) mittels 18F-FDG-Positronenemissionstomographie/ Computertomographie (PET/CT) im Hinblick auf Rezidive. Patienten, Methoden: 37 CMM-Patienten (17 Männer, mittleres Alter: 61,7 ± 13,6 Jahre), bei denen eingangs ein PET/CT durchgeführt worden war, wurden in diese Studie aufgenommen. Ein Rezidiv wurde mittels histologischer Untersuchung oder durch radiologische und klinische Nachkontrollen über mindestens 8 Monate nach kurativer Operation festgestellt. Klinische Variablen wie Alter, Geschlecht, klinisches Stadium, Lokalisation, Dicke und Ulzeration des Primärtumors sowie SUVmax- Werte wurden dahingehend analysiert, wie hilfreich sie für die Rezidivprognose sind. Ergebnisse: SUVmax war signifikant höher bei Patienten mit ulzerierten Primärtumoren eines CMM (p = 0,004) und bei Patienten mit einem Stadium ≥ III (p < 0,000). Patienten mit einem Rezidiv wiesen signifikant höhere mittlere SUVmax-Werte auf (4,9 ± 2,9) als rezidivfreie Patienten (2,1 ± 1,5, p = 0,024). Die ROCAnalyse zeigte für einen Cut-off-Wert von 2,2 des SUVmax eine hohe Sensitivität (88,9%) und Spezifität (67,9%) bei der Prognose eines Rezidivs. In der Kaplan-Meier-Analyse wurden die Ulzeration des Primärtumors (p = 0,034), Stadium ≥ III (p = 0,019) und SUVmax ≥ 2,2 (p = 0,002) als Prädiktoren für ein Rezidiv identifiziert. Die Analyse mittels Cox-proportionalhazard- Modell zeigte jedoch, dass nur der SUVmax (p = 0,025, relatives Risiko 11,063) ein Rezidiv signifikant vorhersagen konnte. Schlussfolgerung: Der präoperative SUVmax des Primärtumors war der stärkste Prädiktor eines Rezidivs bei Patienten mit CMM. Patienten mit hohem SUVmax des Primärtumors sollten im Hinblick auf Rezidive engmaschig nachkontrolliert werden.

Keywords

Cutaneous malignant melanoma - 18F-FDG PET/CT - predicting recurrence - standardized uptake value

Schlüsselwörter

Kutanes malignes Melanom - 18F-FDG PET/CT - Rezidivprognose - standardisierter Aufnahmewert
 

  • References

  • 1 Aloj L, Caracó C, Jagoda E. et al. Glut-1 and hexokinase expression: relationship with 2-fluoro-2-deoxy-D-glucose uptake inA431 and T47D cells in culture. Cancer Res 1999; 59: 4709-4714.
    PubMedSearch in Google Scholar
  • 2 Altekruse SF, Kosary CL, Krapcho M. et al. SEER Cancer Statistics Review, 1975–2007. SEER web site, 2010: http://seer.cancer.gov/csr/1975_2007/
  • 3 Bastiaannet E, Oyen WJ, Meijer S. et al. Impact of [18F] fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg 2006; 93: 243-249.
    CrossrefPubMedSearch in Google Scholar
  • 4 Bastiaannet E, Wobbes T, Hoekstra OS. et al. Prospective comparison of (18F)fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol 2009; 27: 4774-4780.
    CrossrefPubMedSearch in Google Scholar
  • 5 Bastiaannet E, Hoekstra OS, Oyen WJ. et al. Level of fluorodeoxyglucose uptake predicts risk for recurrence in melanoma patients presenting with lymph node metastases. Ann Surg Oncol 2006; 13: 919-926.
    CrossrefPubMedSearch in Google Scholar
  • 6 Bedin V, Adam RL, de Sá BC. et al. Fractal dimension of chromatin is an independent prognostic factor for survival in melanoma. BMC Cancer 2010; 10: 260.
    CrossrefPubMedSearch in Google Scholar
  • 7 Boellaard R, Krak NC, Hoekstra OS. et al. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med 2004; 45: 1519-1527.
    PubMedSearch in Google Scholar
  • 8 Boni R, Boni RA, Steinert H. et al. Staging of metastatic melanoma by whole body positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose. Br J Dermatol 1995; 132: 556-562.
    PubMedSearch in Google Scholar
  • 9 Chung HW, Lee EJ, Cho YH. et al. High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma. J Cancer Res Clin Oncol 2010; 136: 1929-1935.
    CrossrefPubMedSearch in Google Scholar
  • 10 Damian DL, Fulham MJ, Thompson E. et al. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 1996; 6: 325-329.
    CrossrefPubMedSearch in Google Scholar
  • 11 Eary JF, O’Sullivan F, Powitan Y. et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: a retrospective analysis. Eur J Nucl Med Mol Imaging 2002; 29: 1149-1154.
    CrossrefPubMedSearch in Google Scholar
  • 12 Haberkorn U, Strauss LG, Reisser C. et al. Glucose uptake, perfusion, and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med 1991; 32: 1548-1555.
    PubMedSearch in Google Scholar
  • 13 Homsi J, Kashani-Sabet M, Messina JL. et al. Cutaneous melanoma: prognostic factors. Cancer Control 2005; 12: 223-229.
    CrossrefPubMedSearch in Google Scholar
  • 14 Huang SC. Anatomy of SUV. Standardized uptake value. Nucl Med Biol 2000; 27: 643-646.
    CrossrefPubMedSearch in Google Scholar
  • 15 Keyes Jr. JW. SUV: standard uptake or silly useless value?. J Nucl Med 1995; 36: 1836-1839.
    PubMedSearch in Google Scholar
  • 16 Kostakoglu L, Goldsmith SJ. 18F-FDG PET evaluation of the response to therapy for lymphoma and for breast, lung, and colorectal carcinoma. J Nucl Med 2003; 44: 224-239.
    PubMedSearch in Google Scholar
  • 17 Krak NC, Boellaard R, Hoekstra OS. et al. Effects of ROI definition and reconstruction method on quantitative outcome and applicability in a response monitoring trial. Eur J Nucl Med Mol Imaging 2005; 32: 294-301.
    CrossrefPubMedSearch in Google Scholar
  • 18 Kumar R, Mavi A, Bural G. et al. Fluorodeoxyglucose-PET in the management of malignant melanoma. Radiol Clin North Am 2005; 43: 23-33.
    CrossrefPubMedSearch in Google Scholar
  • 19 Mijnhout GS, Hoekstra OS, van Tulder MW. et al. Systematic review of the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography in melanoma patients. Cancer 2001; 91: 1530-1542.
    CrossrefPubMedSearch in Google Scholar
  • 20 Minn H, Joensuu H, Ahonen A. et al. Fluorodeoxyglucose imaging: a method to assess the proliferative activity of human cancer in vivo. Comparison with DNA flow cytometry in head and neck tumors. Cancer 1988; 61: 1776-1781.
    CrossrefPubMedSearch in Google Scholar
  • 21 Minn H, Lapela M, Klemi PJ. et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997; 38: 1907-1911.
    PubMedSearch in Google Scholar
  • 22 Mochiki E, Kuwano H, Katoh H. et al. Evaluation of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography for gastric cancer. World J Surg 2004; 28: 247-253.
    CrossrefPubMedSearch in Google Scholar
  • 23 Nakajo M, Kajiya Y, Kaneko T. et al. FDG PET/CT and diffusion-weighted imaging for breast cancer: prognostic value of maximum standardized uptake values and apparent diffusion coefficient values of the primary lesion. Eur J Nucl Med Mol Imaging 2010; 37: 2011-2020.
    CrossrefPubMedSearch in Google Scholar
  • 24 Oshida M, Uno K, Suzuki M. et al. Predicting the prognoses of breast carcinoma patients with positron emission tomography using 2-deoxy-2-fluoro(18F)-D-glucose. Cancer 1998; 82: 2227-2234.
    CrossrefPubMedSearch in Google Scholar
  • 25 Oyama N, Akino H, Suzuki Y. et al. Prognostic value of 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography imaging for patients with prostate cancer. Mol Imaging Biol 2002; 4: 99-104.
    CrossrefPubMedSearch in Google Scholar
  • 26 Rinne D, Baum RP, Hor G. et al. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: Results of a prospective study of 100 patients. Cancer 1998; 82: 1664-1671.
    CrossrefPubMedSearch in Google Scholar
  • 27 Schwimmer J, Essner R, Patel A. et al. A review of the literature for whole-body FDG PET in the management of patients with melanoma. Q J Nucl Med 2000; 44: 153-167.
    PubMedSearch in Google Scholar
  • 28 Song BI, Lee HJ, Kang SM. et al. Prognostic significance of maximum SUV of primary tumor and axillary lymph nodes on initial F-18 FDG PET/CT in invasive ductal breast cancer. J Nucl Med 2010; 51 (Suppl) 237P.
    CrossrefPubMedSearch in Google Scholar
  • 29 Spatz A, Batist G, Eggermont AM. The biology behind prognostic factors of cutaneous melanoma. Curr Opin Oncol 2010; 22: 163-168.
    CrossrefPubMedSearch in Google Scholar
  • 30 Sperti C, Pasquali C, Chierichetti F. et al. 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma. J Gastrointest Surg 2003; 7: 953-959.
    CrossrefPubMedSearch in Google Scholar
  • 31 Sugawara Y, Quint LE, Iannettoni MD. et al. Does the FDG uptake of primary non-small cell lung cancer predict prognosis? A work in progress. Clin Positron Imaging 1999; 2: 111-118.
    CrossrefPubMedSearch in Google Scholar
  • 32 Van Westreenen HL, Plukker JT, Cobben DC. et al. Prognostic value of the standardized uptake value in esophageal cancer. AJR Am J Roentgenol 2005; 185: 436-440.
    CrossrefPubMedSearch in Google Scholar
  • 33 Vansteenkiste J, Fischer BM, Dooms C. et al. Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review. Lancet Oncol 2004; 5: 531-540.
    CrossrefPubMedSearch in Google Scholar
  • 34 Wagner JD, Schauwecker D, Hutchins G. et al. Initial assessment of positron emission tomography for detection of nonpalpable regional lymphatic metastases in melanoma. J Surg Oncol 1997; 64: 181-189.
    CrossrefPubMedSearch in Google Scholar
  • 35 Wong RJ, Lin DT, Schoder H. et al. Diagnostic and prognostic value of (18F)fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2002; 20: 4199-4208.
    CrossrefPubMedSearch in Google Scholar
  • 36 Zimny M, Fass J, Bares R. et al. Fluorodeoxyglucose positron emission tomography and the prognosis of pancreatic carcinoma. Scand J Gastroenterol 2000; 35: 883-888.
    CrossrefPubMedSearch in Google Scholar