title: A prospective analysis of positron emission tomography and conventional imaging for detection of stage IV metastatic melanoma in patients undergoing metastasectomy.
abstract: BACKGROUND
  Positron emission tomography with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG-PET) is available for evaluation of patients with melanoma. This study evaluates the potential of FDG-PET to improve on conventional imaging (CI) in patients with stage IV melanoma undergoing metastasectomy.
  
  
  METHODS
  This was a prospective study comparing radiological evaluation of patients who underwent metastasectomy for palliation or cure. Patients underwent preoperative evaluation by physical examination, CI by computed tomography and/or magnetic resonance imaging, and FDG-PET. Independent observers performed three separate analyses of CI alone, FDG-PET alone, or FDG-PET read with knowledge of CI (FDG-PET + CI). Abnormalities were reported as benign or malignant and assessed by pathologic analysis or by clinical outcome determined by disease progression detected on serial evaluations.
  
  
  RESULTS
  Ninety-four lesions were noted in 18 patients who underwent preoperative assessment, metastasectomy, and long-term follow up (median, 24 months). Lesion-by-lesion analysis for CI demonstrated a sensitivity of 76%, a specificity of 87%, a positive predictive value (PPV) of 86%, and a negative predictive value (NPV) of 76%. FDG-PET demonstrated a sensitivity of 79%, a specificity of 87%, a PPV of 86%, and an NPV of 80%. For FDG-PET + CI, the sensitivity was 88%, specificity was 91%, and PPV and NPV were 91% and 88%, respectively.
  
  
  CONCLUSIONS
  Combined use of FDG-PET and CI may be an accurate strategy to identify sites of disease in patients with stage IV melanoma being considered for metastasectomy. Interpreted independently, FDG-PET and CI seemed to be equivalent modalities. FDG-PET + CI had both the highest sensitivity on lesion-by-lesion analysis and the best accuracy on patient-by-patient analysis.
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 2338, 9000 Rockville Pike, Bethesda, MD 20892, USA. richard_sherry@nih.gov
authors.forename: Steven E
authors.initials: SE
authors.lastname: Finkelstein
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Carrasquillo
authors.forename: John M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: Barbara
authors.initials: B
authors.lastname: Galen
authors.forename: Peter
authors.initials: P
authors.lastname: Choyke
authors.forename: Donald E
authors.initials: DE
authors.lastname: White
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rosenberg
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18