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Diagnostic Performance of Whole Body Dual Modality ¹⁸F-FDG PET/CT Imaging for N- and M-Staging of Malignant Melanoma: Experience With 250 Consecutive Patients

From the Departments of Nuclear Medicine, Radiology, and Dermatology, University Hospital Bonn, Bonn, Germany

Address reprint requests to Michael J. Reinhardt, MD, Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn, Germany; e-mail: michael.reinhardt{at}ukb.uni-bonn.de

PURPOSE: To assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) using ¹⁸F-fluorodeoxyglucose (FDG) for N- and M-staging of cutaneous melanoma.

PATIENTS AND METHODS: This is a retrospective and blinded study of 250 consecutive patients (105 women, 145 men; age 58 ± 16 years) who underwent FDG-PET/CT for staging of cutaneous melanoma at different time points in the course of disease. Whole-body FDG-PET/CT was performed 101 ± 21 minutes postinjection of 371 ± 41 MBq FDG. Diagnostic accuracy for N- and M-staging was determined for CT alone, PET alone, and PET/CT.

RESULTS: PET/CT detected significantly more visceral and nonvisceral metastases than PET alone and CT alone (98.7%, 88.8%, and 69.7%, respectively). PET/CT imaging thus provided significantly more accurate interpretations regarding overall N- and M-staging than PET alone and CT alone. Overall N- and M-stage was correctly determined by PET/CT in 243 of 250 patients (97.2%; 95% CI, 95.2% to 99.4%) compared with 232 patients (92.8%; 95% CI, 89.6% to 96.0%) by PET, and 197 patients (78.8%; 95% CI, 73.7% to 83.9%) by CT. All differences were significant. Accuracy of PET/CT was significantly higher than that of PET and CT for M-staging (0.98 v 0.93 and 0.84) and significantly higher than that of CT for N-Staging (0.98 v 0.86). Change of treatment according to PET/CT findings occurred in 121 patients (48.4%).

CONCLUSION: The diagnostic performance of FDG-PET/CT for N- and M-staging of melanoma patients suggests its use for whole-body tumor staging, especially for detection or exclusion of distant metastases.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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