Brady Mary S, Akhurst Timothy, Spanknebel Kathryn, Hilton Susan, Gonen Mithat, Patel Ami, Larson Steven
Department of Surgery, Memorial Sloan-Kettering Cancer Center, and Department of Surgery, Columbia University Medical Center, New York, New York 10021, USA.
Ann Surg Oncol. 2006 Apr;13(4):525-32. doi: 10.1245/ASO.2006.02.008. Epub 2006 Feb 15.
[(18)]F Fluorodeoxyglucose-positron emission tomography (PET) scanning provides functional imaging based on glucose uptake by tumors. Melanoma is a glucose-avid malignancy, and preoperative PET scanning in melanoma patients has the potential to guide appropriate treatment.
We performed a prospective trial to evaluate the clinical utility of whole-body fluorine 18-labeled deoxyglucose-PET scanning used in addition to standard imaging (contrast-enhanced computed tomographic [CT] imaging of the chest, abdomen, and pelvis) in preoperative stage IIC (T4N0M0), III (any T, N1 to N3, M0), and IV (any T, any N, M1) melanoma patients. Pathologic or clinical follow-up within 4 to 6 months of the imaging studies was used to determine the accuracy of preoperative PET and CT scan findings.
Preoperative imaging findings led to a change in clinical management in 36 (35%) of 103 patients. In 32 (89%) of these patients, the information was accurate. Findings on PET scan alone (14 of 36; 39%) or in combination with CT (20 of 36; 56%) resulted in a treatment change in most patients (34 of 36; 94%). The most common decision was to cancel the operation (19 of 36; 53%). PET scanning was more sensitive than CT scanning in detecting occult disease (68% vs. 48%; P=.05), but both tests were highly specific (92% vs. 95%; P=.7, PET vs. CT).
PET scanning facilitates the appropriate management of high-risk melanoma patients being considered for operative intervention. PET imaging in addition to CT scanning should be strongly considered before operation in patients at high risk for occult metastatic disease.
[18F]氟脱氧葡萄糖正电子发射断层扫描（PET）基于肿瘤对葡萄糖的摄取提供功能成像。黑色素瘤是一种摄取葡萄糖的恶性肿瘤，黑色素瘤患者术前PET扫描有可能指导恰当的治疗。
我们进行了一项前瞻性试验，以评估在术前IIC期（T4N0M0）、III期（任何T，N1至N3，M0）和IV期（任何T，任何N，M1）黑色素瘤患者中，除标准成像（胸部、腹部和骨盆的对比增强计算机断层扫描[CT]成像）外，使用全身氟-18标记脱氧葡萄糖-PET扫描的临床效用。在成像研究后的4至6个月内进行病理或临床随访，以确定术前PET和CT扫描结果的准确性。
术前成像结果导致103例患者中的36例（35%）临床管理发生改变。在这些患者中的32例（89%）中，信息是准确的。仅PET扫描结果（36例中的14例；39%）或与CT联合结果（36例中的20例；56%）导致大多数患者（36例中的34例；94%）治疗改变。最常见的决定是取消手术（36例中的19例；53%）。PET扫描在检测隐匿性疾病方面比CT扫描更敏感（68%对48%；P = 0.05），但两种检查的特异性都很高（92%对95%；P = 0.7，PET对CT）。
PET扫描有助于对考虑进行手术干预的高危黑色素瘤患者进行恰当管理。对于有隐匿性转移疾病高风险的患者，术前除CT扫描外，应强烈考虑进行PET成像。
