Role of PET in the initial staging of cutaneous malignant melanoma: systematic review.
OBJECTIVE
To calculate summary estimates of the diagnostic performance of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging in the initial staging of cutaneous malignant melanoma (CMM), following the new American Joint Committee on Cancer (AJCC) staging classification on per-patient and per-lesion bases.


METHODS
MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews databases, and reference lists of reviews and included papers were searched, without any language restrictions, for relevant articles published before March 2007. Two reviewers independently assessed study eligibility and methodologic quality by using the quality assessment of diagnostic accuracy studies checklist. A pooled random effect was estimated and a fixed coefficient regression model was used to explore the existing heterogeneity.


RESULTS
Twenty-eight studies involving 2905 patients met the inclusion criteria. The pooled estimates of FDG PET for the detection of metastasis in the initial staging of CMM were sensitivity, 83% (95% confidence interval [CI]: 81%, 84%); specificity, 85% (95% CI: 83%, 87%); positive likelihood ratio (LR), 4.56 (95% CI: 3.12, 6.64); negative LR, 0.27 (95% CI: 0.18, 0.40); and diagnostic odds ratio, 19.8 (95% CI: 10.8, 36.4). Results from eight studies suggested that FDG PET was associated with 33% disease management changes (range, 15%-64%).


CONCLUSIONS
There is good preliminary evidence that FDG PET is useful for the initial staging of patients with CMM, especially as adjunctive role in AJCC stages III and IV, to help detect deep soft-tissue, lymph node, and visceral metastases. FDG PET-computed tomographic imaging seemed to be more precise than PET alone, as suggested by four eligible studies. Further evaluation by using a well-designed prospective study, with clinical outcome-focused measures and cost effectiveness analysis, is needed to clarify the appropriate role of FDG PET in CMM staging.


BACKGROUND
http://radiology.rsnajnls.org/cgi/content/full/249/3/836/DC1.
Krug
Bruno
B
Nuclear Medicine Division, Mont-Godinne University Hospital, Université Catholique de Louvain, 1 Dr Therasse, B-5530 Yvoir, Belgium.
Crott
Ralph
R
Lonneux
Max
M
Baurain
Jean-François
JF
Pirson
Anne-Sophie
AS
Vander Borght
Thierry
T
D019788:Fluorodeoxyglucose F18; D006801:Humans; D008545:Melanoma / Q000000981:diagnostic imaging*; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009367:Neoplasm Staging / Q000379:methods*; D016017:Odds Ratio; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000000981:diagnostic imaging*
D019788:Fluorodeoxyglucose F18