Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma

J. Lewin, L. Sayers, D. Kee, I. Walpole, A. Sanelli, L. Te Marvelde, A. Herschtal, J. Spillane, D. Gyorki, D. Speakman, V. Estall, S. Donahoe, M. Pohl, K. Pope, M. Chua, S. Sandhu, G. A. McArthur, C. J. McCormack, M. Henderson, R. J. Hicks & 1 others Mark Shackleton

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Abstract

Background: As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance. Patients and methods: From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were carried out of imaging outcomes. Results: One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56%-83%. Negative scans had predictive values of 89%-96% for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18months had NPVs of 80%-84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24months (median). Conclusions: Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

Original languageEnglish
Pages (from-to)1569-1574
Number of pages6
JournalAnnals of Oncology
Volume29
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Melanoma
  • PET
  • Stage 3
  • Surveillance

Cite this

Lewin, J. ; Sayers, L. ; Kee, D. ; Walpole, I. ; Sanelli, A. ; Te Marvelde, L. ; Herschtal, A. ; Spillane, J. ; Gyorki, D. ; Speakman, D. ; Estall, V. ; Donahoe, S. ; Pohl, M. ; Pope, K. ; Chua, M. ; Sandhu, S. ; McArthur, G. A. ; McCormack, C. J. ; Henderson, M. ; Hicks, R. J. ; Shackleton, Mark. / Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. In: Annals of Oncology. 2018 ; Vol. 29, No. 7. pp. 1569-1574.
@article{63a3fca082ef4c6c97a72dac60834844,
title = "Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma",
abstract = "Background: As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance. Patients and methods: From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were carried out of imaging outcomes. Results: One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38{\%}) patients, of which 45 (69{\%}) were asymptomatic. False-positive imaging findings occurred in 7{\%}, and 6{\%} had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56{\%}-83{\%}. Negative scans had predictive values of 89{\%}-96{\%} for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18months had NPVs of 80{\%}-84{\%} for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70{\%} and 87{\%}, respectively. Of relapsed patients, 33 (52{\%}) underwent potentially curative resection and 10 (16{\%}) remained disease-free after 24months (median). Conclusions: Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.",
keywords = "Melanoma, PET, Stage 3, Surveillance",
author = "J. Lewin and L. Sayers and D. Kee and I. Walpole and A. Sanelli and {Te Marvelde}, L. and A. Herschtal and J. Spillane and D. Gyorki and D. Speakman and V. Estall and S. Donahoe and M. Pohl and K. Pope and M. Chua and S. Sandhu and McArthur, {G. A.} and McCormack, {C. J.} and M. Henderson and Hicks, {R. J.} and Mark Shackleton",
year = "2018",
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Lewin, J, Sayers, L, Kee, D, Walpole, I, Sanelli, A, Te Marvelde, L, Herschtal, A, Spillane, J, Gyorki, D, Speakman, D, Estall, V, Donahoe, S, Pohl, M, Pope, K, Chua, M, Sandhu, S, McArthur, GA, McCormack, CJ, Henderson, M, Hicks, RJ & Shackleton, M 2018, 'Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma', Annals of Oncology, vol. 29, no. 7, pp. 1569-1574. https://doi.org/10.1093/annonc/mdy124

Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. / Lewin, J.; Sayers, L.; Kee, D.; Walpole, I.; Sanelli, A.; Te Marvelde, L.; Herschtal, A.; Spillane, J.; Gyorki, D.; Speakman, D.; Estall, V.; Donahoe, S.; Pohl, M.; Pope, K.; Chua, M.; Sandhu, S.; McArthur, G. A.; McCormack, C. J.; Henderson, M.; Hicks, R. J.; Shackleton, Mark.

In: Annals of Oncology, Vol. 29, No. 7, 01.07.2018, p. 1569-1574.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma

AU - Lewin, J.

AU - Sayers, L.

AU - Kee, D.

AU - Walpole, I.

AU - Sanelli, A.

AU - Te Marvelde, L.

AU - Herschtal, A.

AU - Spillane, J.

AU - Gyorki, D.

AU - Speakman, D.

AU - Estall, V.

AU - Donahoe, S.

AU - Pohl, M.

AU - Pope, K.

AU - Chua, M.

AU - Sandhu, S.

AU - McArthur, G. A.

AU - McCormack, C. J.

AU - Henderson, M.

AU - Hicks, R. J.

AU - Shackleton, Mark

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance. Patients and methods: From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were carried out of imaging outcomes. Results: One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56%-83%. Negative scans had predictive values of 89%-96% for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18months had NPVs of 80%-84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24months (median). Conclusions: Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

AB - Background: As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance. Patients and methods: From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were carried out of imaging outcomes. Results: One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56%-83%. Negative scans had predictive values of 89%-96% for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18months had NPVs of 80%-84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24months (median). Conclusions: Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

KW - Melanoma

KW - PET

KW - Stage 3

KW - Surveillance

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U2 - 10.1093/annonc/mdy124

DO - 10.1093/annonc/mdy124

M3 - Article

VL - 29

SP - 1569

EP - 1574

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 7

ER -

Lewin J, Sayers L, Kee D, Walpole I, Sanelli A, Te Marvelde L et al. Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. Annals of Oncology. 2018 Jul 1;29(7):1569-1574. https://doi.org/10.1093/annonc/mdy124