Klein M, Freedman N, Lotem M, Marciano R, Moshe S, Gimon Z, Chisin R
Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel.
Nuklearmedizin. 2000;39(3):56-61.
This pilot study describes use of whole body PET (WB PET) for staging of melanoma. WB PET in conjunction with lymphoscintigraphy (LS) for evaluating status of the sentinel lymph node (SLN) in primary melanoma was investigated with comparison to histopathological results. WB PET was also used both for primary and metastatic melanoma for screening for distant metastases, restaging and follow-up.
Group I: 17 patients with primary cutaneous melanoma underwent LS, WB PET and SLN dissection. WB PET findings were compared with biopsy results at the SLN site and were used for screening for distant metastases. Group II: 17 patients with a history of melanoma underwent WB PET for follow-up and/or restaging. Results were confirmed or refuted by other radiological modalities or by biopsy or clinical follow-up.
Group I: out of 20 SLNs identified by LS in the 17 patients, 18 were negative on WB PET and 2 were positive. 19/20 WB PET findings were confirmed either by histopathology or by clinical follow-up (20 mo). Accuracy was 94% for the assessment of the status of the SLN. Group II: WB PET findings altered staging and treatment in 12/17 patients and confirmed the validity of treatment in 3/17 patients. Overall, in 15/17 patients (88%), WB PET had an impact on treatment strategy.
Further studies are required to demonstrate if WB PET can become a reliable non-invasive alternative to surgery in the characterization of the SLN. WB PET is important as a baseline in primary localized melanoma and decisively impacts patient management in metastatic melanoma.
本初步研究描述了全身正电子发射断层扫描（WB PET）在黑色素瘤分期中的应用。研究了WB PET联合淋巴闪烁显像（LS）评估原发性黑色素瘤前哨淋巴结（SLN）状态，并与组织病理学结果进行比较。WB PET还用于原发性和转移性黑色素瘤的远处转移筛查、再分期及随访。
第一组：17例原发性皮肤黑色素瘤患者接受了LS、WB PET及SLN切除。将WB PET检查结果与SLN部位的活检结果进行比较，并用于远处转移筛查。第二组：17例有黑色素瘤病史的患者接受WB PET进行随访和/或再分期。结果通过其他放射学检查方法、活检或临床随访得以证实或否定。
第一组：在17例患者中，LS识别出20个SLN，其中18个在WB PET检查中为阴性，2个为阳性。20个WB PET检查结果中有19个经组织病理学或临床随访（20个月）得以证实。评估SLN状态的准确率为94%。第二组：WB PET检查结果改变了17例患者中12例的分期和治疗方案，并证实了17例患者中3例治疗的有效性。总体而言，17例患者中有15例（88%），WB PET对治疗策略产生了影响。
需要进一步研究以证明WB PET能否成为一种可靠的非侵入性方法替代手术用于SLN的特征性评估。WB PET作为原发性局限性黑色素瘤的基线检查很重要，并且对转移性黑色素瘤患者的管理有决定性影响。
