title: FDG-PET sensitivity for melanoma lymph node metastases is dependent on tumor volume.
abstract: OBJECTIVE
  The purpose of this study is to determine the tumor volume threshold for successful positron emission tomography (PET) imaging of melanoma nodal metastases.
  
  
  METHODS
  Review of a clinical series of patients who had FDG-PET imaging of regional lymph node basins followed by lymphadenectomy. Lymph node tumor volumes were calculated from direct measurements of metastatic nodule(s) in formalin fixed specimens. PET scan interpretations were correlated with histology to determine sensitivity. Sensitivity was correlated with the aggregate lymph node tumor volume in the nodal basin and with AJCC stage group.
  
  
  RESULTS
  Forty-five patients with 49 pathologically positive regional nodal basins comprised the study group. Median total basin tumor volume was 28.3 mm(3)(range 0.004-22,879 mm(3)). FDG-PET sensitivity for detection of all tumor volumes was 0.49. The observed 90% sensitivity threshold for detection of nodal metastases was > or = 78 mm(3). PET sensitivity was 0.14 for detection of tumor volumes < 78 mm(3). PET sensitivity differed by prescan AJCC stage: I-0.0; II-0.24; III-0.81; IV-1.0 (P < 0.001).
  
  
  CONCLUSIONS
  FDG-PET reliably detects lymph node tumor deposits greater than approximately 80 mm(3) volume, but sensitivity falls rapidly below this. This amount of tumor is most likely to occur in patients with AJCC stage III or IV disease.
authors.affiliation: Indiana University School of Medicine, Department of Surgery, Indiana University-Purdue University at Indianapolis, Indianapolis, IN 46202, USA. jdwagner@iupui.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Wagner
authors.forename: D S
authors.initials: DS
authors.lastname: Schauwecker
authors.forename: D
authors.initials: D
authors.lastname: Davidson
authors.forename: S
authors.initials: S
authors.lastname: Wenck
authors.forename: S H
authors.initials: SH
authors.lastname: Jung
authors.forename: G
authors.initials: G
authors.lastname: Hutchins
mesh_terms: D019788:Fluorodeoxyglucose F18; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18