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Utility of PET-CT in Detecting Occult alignancy in Sentinel Lymph Node-Positive Melanoma
*Jacqueline Paolino
Tufts Medical Center, Boston, MA
Utility of PET-CT in detecting occult malignancy in sentinel-lymph node-positive melanoma
1.Objective.
The NCCN guidelines for melanoma currently recommend that patients with stage III sentinel node positive melanoma undergo PET/CT for baseline staging prior to offering completion lymph node dissection. The aim of this study is to evaluate how often PET/CT changes management in this patient population at Tufts Medical Center.
2. Design.
Retrospective chart review
3. Setting.
Tufts Medical Center outpatients.
4. Patients.
Adult patients who had sentinel node positive melanoma and underwent a PET CT prior to further intervention between 1/1/2000 and 12/31/2015.
5. Interventions.
None.
6. Main Outcome Measures
The first outcome is how often PET/CT changed management, including preventing completion lymph node dissection or identifying metastatic disease. The second outcome is how often PET/CT resulted in additional diagnostic testing.
7. Results.
Thirty patients met inclusion criteria (12 female, average age 60.6; 18 male, average age 63.6). PET/CT changed management in 0/30 patients (0%) and resulted in additional testing in 4/30 patients (13.3%), including additional imaging, specialist visits, and biopsies. All four patients underwent completion lymph node dissection. One of the four patients was identified as having early recurrence at a site seen on PET/CT that had been further investigated with ultrasound but not biopsied. The sensitivity and specificity of PET/CT in this population was 100% and 89.6%, respectively.
8. Conclusions
In patients with stage III sentinel node positive melanoma, PET/CT did not change management despite further testing in 13% of patients. While it has a high specificity and sensitivity, its utility should be investigated in more rigorous trials.
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