title: Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis.
abstract: BACKGROUND
  Meta-analyses were performed to examine the utility of ultrasonography, computed tomography (CT), positron emission tomography (PET), and a combination of both (PET-CT) for the staging and surveillance of melanoma patients.
  
  
  METHODS
  Patient-level data from 74 studies containing 10,528 patients (between January 1, 1990, and June, 30, 2009) were used to derive characteristics of the diagnostic tests used. Meta-analyses were conducted by use of Bayesian bivariate binomial models to estimate sensitivity and specificity. Diagnostic odds ratios [ie, true-positive results/false-negative results)/(false-positive results/true-negative results)] and their 95% credible intervals (CrIs) and positive predictive values were used as indicators of test performance.
  
  
  RESULTS
  Among the four imaging methods examined for the staging of regional lymph nodes, ultrasonography had the highest sensitivity (60%, 95% CrI = 33% to 83%), specificity (97%, 95% CrI = 88% to 99%), and diagnostic odds ratio (42, 95% CrI = 8.08 to 249.8). For staging of distant metastases, PET-CT had the highest sensitivity (80%, 95% CrI = 53% to 93%), specificity (87%, 95% CrI = 54% to 97%), and diagnostic odds ratio (25, 95% CrI = 3.58 to 198.7). Similar trends were observed for melanoma surveillance of lymph node involvement, with ultrasonography having the highest sensitivity (96%, 95% CrI = 85% to 99%), specificity (99%, 95% CrI = 95% to 100%), and diagnostic odds ratio (1675, 95% CrI = 226.6 to 15,920). For distant metastases, PET-CT had the highest sensitivity (86%, 95% CrI = 76% to 93%), specificity (91%, 95% CrI = 79% to 97%), and diagnostic odds ratio (67, 95% CrI = 20.42 to 229.7). Positive predictive values were likewise highest for ultrasonography in lymph node staging and for PET-CT in detecting distant metastases.
  
  
  CONCLUSIONS
  Among the compared modalities, ultrasonography was superior for detecting lymph node metastases, and PET-CT was superior for the detection of distant metastases in both the staging and surveillance of melanoma patients.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xing
authors.forename: Yulia
authors.initials: Y
authors.lastname: Bronstein
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Robert L
authors.initials: RL
authors.lastname: Askew
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Richard
authors.initials: R
authors.lastname: Royal
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
mesh_terms: D001499:Bayes Theorem; D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011159:Population Surveillance / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography