title: Breslow thickness and (18)F-FDG PET-CT result in initial staging of cutaneous melanoma: Can a cut-off point be established?
abstract: OBJECTIVE
  To establish a Breslow Thickness (BT) cut-off point for indication of PET-CT of cutaneous melanoma in early stages and evaluate its prognostic value.
  
  
  METHODS
  Retrospective analysis of 347 PET-CT studies with diagnosis of melanoma, of which 108 were performed for initial staging. Thirty-one patients were excluded, and a final sample of 77 patients remained. A ROC curve analysis was performed to establish an optimal cut-off point. A survival analysis was performed, considering death assignable to melanoma as the main event, for the evaluation of its prognostic value.
  
  
  RESULTS
  Forty-seven (61.04%) of all 77 patients selected were men, and 11 (14.29%) had a positive PET-CT result. Mean age was 65.17±15.00 years. The median BT in patients with a negative PET-CT result was 2.75 mm (IQR 1.83-4.50) and in the positive group 6.25 mm (IQR 5.40-7.50) (P=.0013). In the ROC curve analysis (AUC 0.804, SE 0.054), an optimal value of 5 mm BT with the following values was obtained: sensitivity 90.91%, specificity 78.79%, negative predictive value (NPV) 98.1%, positive predictive value (PPV) 41.7%, diagnostic OR 37.1, and accuracy 80.52%. Mean follow-up was 18.66±14,35 months, detecting 2/53 (3.77%) deaths in the BT<5 mm group, and 7/24 (29.17%) in the BT≥5 mm group. Survival curves between both groups were significantly different (P=.0013).
  
  
  CONCLUSIONS
  A 5 mm cut-off point correctly distinguishes those patients with positive PET-CT from those with negative results in the early stages of cutaneous melanoma; therefore it could be included in initial staging of this subgroup of patients.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España. Electronic address: aidaisotopo@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Ortega-Candil
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez-Rey
authors.affiliation: Servicio de Cardiología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Cano-Carrizal
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Cala-Zuluaga
authors.affiliation: Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: J L
authors.initials: JL
authors.lastname: González Larriba
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Jiménez-Ballvé
authors.affiliation: Unidad de Gestión Clínica de Medicina Preventiva, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: M E
authors.initials: ME
authors.lastname: Fuentes-Ferrer
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: M N
authors.initials: MN
authors.lastname: Cabrera-Martín
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Castejón
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: García García-Esquinas
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Lapeña-Gutierrez
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Carreras-Delgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Breslow thickness; Estadificación; Melanoma; PET-CT; PET-TC; Staging; Índice de Breslow