Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients
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Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients. / Helvind, Neel Maria; Aros Mardones, Catalina Aurora; Hölmich, Lisbet Rosenkrantz; Hendel, Helle Westergren; Bidstrup, Pernille Envold; Sørensen, Jens Ahm; Chakera, Annette Hougaard.
I: European Journal of Surgical Oncology, Bind 47, Nr. 12, 2021, s. 3020-3027.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients
AU - Helvind, Neel Maria
AU - Aros Mardones, Catalina Aurora
AU - Hölmich, Lisbet Rosenkrantz
AU - Hendel, Helle Westergren
AU - Bidstrup, Pernille Envold
AU - Sørensen, Jens Ahm
AU - Chakera, Annette Hougaard
N1 - Publisher Copyright: © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2021
Y1 - 2021
N2 - Introduction: The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. Materials and methods: Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. Results: In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). Conclusion: Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients.
AB - Introduction: The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. Materials and methods: Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. Results: In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). Conclusion: Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients.
KW - 18F-FDG PET-CT
KW - Asymptomatic recurrence
KW - Melanoma
KW - Routine imaging
KW - Surveillance
U2 - 10.1016/j.ejso.2021.06.011
DO - 10.1016/j.ejso.2021.06.011
M3 - Journal article
C2 - 34120809
AN - SCOPUS:85107813431
VL - 47
SP - 3020
EP - 3027
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
SN - 0748-7983
IS - 12
ER -
ID: 273651868