title: 18F-FDG PET/CT and Melanoma: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management.
abstract: OBJECTIVE
  We aimed to evaluate the added value of performing fourth and subsequent follow-up F-FDG-PET/CT scans to clinical assessment and impact on the patient's management in patients with melanoma.
  
  
  METHODS
  This was a retrospective study of 232 biopsy-proven melanoma patients who underwent F-FDG-PET/CT scans. Of these, 71 patients had 4 or more follow-up F-FDG-PET/CT scans after completion of primary treatment, with a total of 246 fourth or subsequent follow-up PET/CT scans. The added value of each follow-up PET/CT scan to the patient's clinical assessment and treatment management was established. Kaplan-Meier plots with a Mantel-Cox log-rank test were used to establish the patient's overall survival.
  
  
  RESULTS
  Of the 246 fourth and subsequent follow-up PET/CT scans, 61% (150/246) were negative for malignancy, and 39.0% (96/246) were positive for recurrence/metastases. FDG-PET/CT was helpful in identifying malignancy in 6.5% of the scans performed without prior clinical suspicion, which ruled out malignancy in 28.5% of the scans obtained with prior clinical signs suggestive of recurrence or for secondary therapy assessment. The PET/CT scan resulted in change of the patient's management in approximately 16.7% (41/246) of the scans. Change in management was significantly greater in patients whose scans were done with prior clinical signs suggestive of malignancy, or for therapy assessment than without prior clinical suspicion (29.3% vs 4.1%; P < 0.0001). Statistically significant difference was seen in the overall survival between patients with at least 1 positive and all negative fourth and subsequent follow-up PET/CT scans at patient level (P = 0.001).
  
  
  CONCLUSIONS
  The fourth and subsequent F-FDG-PET/CT scans obtained after completion of primary treatment added value to clinical assessment in patients with melanoma. Patients with clinical signs suggestive of recurrence or metastases or being monitored for treatment response are more likely to benefit from the fourth or subsequent FDG PET/CT than those without prior clinical suspicion.
authors.affiliation: From the *Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD; †Boston University School of Medicine, Boston, MA; ‡Department of Oncology, Sidney Kimmel Comprehensive Cancer Centre, §Armstrong Institute for Patient Safety & Quality, Johns Hopkins School of Medicine; and ∥Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Esther
authors.initials: E
authors.lastname: Mena
authors.forename: Mehdi
authors.initials: M
authors.lastname: Taghipour
authors.forename: Sara
authors.initials: S
authors.lastname: Sheikhbahaei
authors.forename: Sahar
authors.initials: S
authors.lastname: Mirpour
authors.forename: Jennifer
authors.initials: J
authors.lastname: Xiao
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18