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| |  FDG-PET May Detect More Bone and Skin Metastases Than Spiral CT in Melanoma Patients With Palpable Lymph Node Metastases: Presented at ESSO By Shazia Qureshi THE HAGUE, Netherlands -- September 15, 2008 -- In patients with stage III melanoma and palpable lymph node metastases, use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can detect significantly more metastatic sites than does spiral computed tomography (CT), according to a study presented here at the 14th Congress of the European Society of Surgical Oncology (ESSO). The study is the first head-to-head comparison of FDG-PET and spiral CT in stage III melanoma patients, according to lead author Harald Hoekstra, MD, PhD, Department of Surgical Oncology, University Medical Centre Groningen, Groningen, The Netherlands. Dr. Hoekstra presented the results of the prospective, multicentre study on September 12. For their study, the investigators enrolled 251 patients with American Joint Committee on Cancer (AJCC)-defined stage III melanoma and palpable, proven lymph node metastases. All patients underwent whole-body FDG-PET and whole-body spiral CT, with a median time of 5 days between the scans. According to the study findings, 141 metastatic sites were detected with FDG-PET compared with 112 sites detected with spiral CT (P = .017). FDG-PET was significantly better than spiral CT at detecting bone (29 vs 10 metastases, respectively; P < .0001) and skin metastases (12 vs 5, respectively; P = .03). Distant metastases were suspected in 79 patients (31.5%) when FDG-PET was used and in 72 patients with spiral CT (28.7%; P = .262). The upstaging was correct in a similar proportion of patients with both FDG-PET and spiral CT (27.1% vs 24.3%; P = .178). The surgeons altered the intended surgical treatment -- mostly to chemotherapy -- as a result of scanning results in 48 patients (19.1%). The treatment plan was changed because of both scans in 38 of these patients (79.2%), because of FDG-PET alone in 8 patients (16.6%), and because of spiral CT alone in 2 patients (4.2%). FDG-PET showed more metastatic sites than spiral CT in 12 patients (4.8%) with distant metastases. The researchers found that FDG-PET offered additional value above that of spiral CT in 22 patients (8.8%). The spiral CT results were false positive in 6 of these patients and FDG-PET detected distant metastases that were not found with spiral CT in 16 patients. Dr. Hoekstra said that the research group is currently conducting a cost-effectiveness study of the 2 techniques.
[Presentation title: Prospective Comparison of FDG-PET and CT in 251 Melanoma Patients With Lymph Node Metastases; Diagnostic Accuracy and Impact on Surgical Treatment. Abstract 181]
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