Frary Evan C, Gad Dorte, Bastholt Lars, Hess Søren
Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
EJNMMI Res. 2016 Dec;6(1):73. doi: 10.1186/s13550-016-0228-1. Epub 2016 Oct 5.
On April 1, 2015, Odense University Hospital (OUH) began a new diagnostic strategy, wherein all malignant melanoma (MM) patients in the Region of Southern Denmark with a positive sentinel lymph node biopsy (SLNB) underwent FDG-PET/CT preoperatively prior to lymph node dissection (LND). The purpose of this study is to determine FDG-PET/CT's efficacy in finding distant metastasis in the first year after the implementation of this new strategy, and to what extent these findings influence subsequent diagnostic testing and treatment in this patient group. We conducted a retrospective multicenter cohort study which included all patients with MM from all hospitals in the Region of Southern Denmark from April 1, 2015 to April 1, 2016 found to be SLNB-positive who subsequently underwent FDG-PET/CT. Patient information was acquired from the Danish Melanoma Database and was cross-referenced with OUH's patient records. The data was analyzed for a number of parameters including FDG-PET/CT findings and treatment strategy. Median follow-up time was 7 months.
A total of 47 patients were eligible from the first year of this new diagnostic strategy. One patient was excluded due to undergoing LND prior to FDG-PET/CT. Thus, 46 patients were included in this study. Ultimately, preoperative FDG-PET/CT neither uncovered any distant metastases nor led to any alterations in treatment strategy in this patient group.
Surprisingly, this new diagnostic strategy did not find any MM metastases or uncover anything else of relevance. FDG-PET/CT did, however, provide false positive findings in 13 % (6/46) of these patients. These scans triggered additional, predominantly invasive, procedures, which did not ultimately have an impact on the therapeutic strategy. Thus, these findings indicate a need for re-evaluation of this new diagnostic strategy as well as the necessity for further clinical trials evaluating FDG-PET/CT's utility in this clinical setting.
2015年4月1日，欧登塞大学医院（OUH）开始采用一种新的诊断策略，即丹麦南部地区所有前哨淋巴结活检（SLNB）呈阳性的恶性黑色素瘤（MM）患者在淋巴结清扫术（LND）前接受术前FDG-PET/CT检查。本研究的目的是确定在实施这一新策略后的第一年，FDG-PET/CT在发现远处转移方面的有效性，以及这些发现对该患者群体后续诊断检查和治疗的影响程度。我们进行了一项回顾性多中心队列研究，纳入了2015年4月日至2016年4月1日丹麦南部地区所有医院中所有SLNB呈阳性且随后接受FDG-PET/CT检查的MM患者。患者信息从丹麦黑色素瘤数据库中获取，并与OUH的患者记录进行交叉核对。对包括FDG-PET/CT检查结果和治疗策略在内的多个参数进行了数据分析。中位随访时间为7个月。
在这一新诊断策略实施的第一年，共有47例患者符合条件。1例患者因在FDG-PET/CT检查前接受了LND而被排除。因此，本研究纳入了46例患者。最终，术前FDG-PET/CT既未发现任何远处转移，也未导致该患者群体的治疗策略发生任何改变。
令人惊讶的是，这一新诊断策略未发现任何MM转移灶或其他相关情况。然而，FDG-PET/CT在这些患者中有13%（6/46）出现了假阳性结果。这些扫描引发了额外的、主要是侵入性的检查，最终对治疗策略没有影响。因此，这些发现表明需要重新评估这一新诊断策略，以及进一步开展临床试验评估FDG-PET/CT在该临床环境中的效用的必要性。
