Marko M, Leško P, Jurenová D, Furda R, Greguš M
Cesk Slov Oftalmol. 2020 Winter;76(1):37-44. doi: 10.31348/2020/5.
Diagnostic and therapeutic management of the patient with malignant uveal melanoma (MMU) is subject to ongoing efforts to innovate. PET/CT (Positron Emission Tomography / Computed Tomography) examination is important in both diagnosis and metastases.
Evaluation of the importance of PET/CT examination in the group of patients diagnosed with MMU in the period 12.1.2016 to 6.12.2018. All patients with a diagnosis of secondary retinal detachment, suspected uveal melanoma, underwent standard examinations to detect possible metastases (liver ultrasound, chest X-ray). Patients for whom a stereotactic radiosurgery solution was planned due to the stage of the disease this examination was to exclude metastasis in the liver or lungs. PET/CT examination is part of the protocol within the exclusion criteria for treatment with stereotactic radiosurgery in one day session surgery.
In the group of 84 patients, 47 women (56 %) and 37 men (44 %) were aged between 26 and 90 years. Their average age was 61.4 years. The median group was 64 years, modus 65 years. Of 84 patients, 79 (94 % of cases) had a diagnosis of C69.3 (choroidal melanoma) and 5 patients (6 % of cases) had a diagnosis of C69.4 (ciliary body melanoma). Subsequent PET/CT examination in many patients did not reveal hypermetabolic manifestations that could involve various pathological processes, in others the radiopharmaceutical was captured in the primary tumor area of the uveal tract. Hypermetabolism in eye globe was only found in melanomas with a volume of more than 0.5 cm3. PET/CT examinations were 85, with one patient undergoing examination twice. However, in 25 patients (26 examinations), the radiopharmaceutical was taken up in places that subsequently required closer attention. The initial aim of the examination was to locate possible metastases of MMU. In the others, 3 incidents have been reported: increased metabolism in the lung and liver, thyroid and mediastinal lymph nodes. Of the 85 examinations, 26 (30.6 %) resulted in a hypermetabolic manifestation of accumulation, which was not located in the eye tract, resp. right in the eye. Two malignancies (prostatic carcinoma and rectosigmal carcinoma) have occurred in two patients. Very important was the discovery of MMU metastasis in the liver, which confirmed the important role of PET/CT examination in the management of MMU patients. The metastasis was discovered after repeated PET/CT examination.
PET/CT examination is a technically demanding examination and is one of the possibilities of imaging intraocular melanoma in tumors with volume more than 0.5 cm3. It is important in determining the grading and staging of the disease before radiosurgical treatment and also in detecting possible metastases after MMU treatment in cases where ultrasound or MRI examinations do not give a definite result. However, our study confirmed the significance of this examination for randomly detected 2 duplex malignancies (2.4%) and 3 incidentalomas (3.6%) in patients whose ophthalmologist diagnosed uveal melanoma and sent patients for full-body PET/CT examination.
恶性葡萄膜黑色素瘤（MMU）患者的诊断和治疗管理一直在不断创新。正电子发射断层扫描/计算机断层扫描（PET/CT）检查在诊断和转移方面都很重要。
评估2016年1月12日至2018年12月6日期间确诊为MMU的患者群体中PET/CT检查的重要性。所有诊断为继发性视网膜脱离、疑似葡萄膜黑色素瘤的患者均接受了标准检查以检测可能的转移（肝脏超声、胸部X线）。由于疾病阶段而计划进行立体定向放射外科治疗的患者，该项检查用于排除肝脏或肺部转移。PET/CT检查是一日手术中立体定向放射外科治疗排除标准方案的一部分。
在84例患者中，47例女性（56%）和37例男性（44%），年龄在26至90岁之间。他们的平均年龄为61.4岁。中位数组为64岁，众数为65岁。84例患者中，79例（94%）诊断为C69.3（脉络膜黑色素瘤），5例（6%）诊断为C69.4（睫状体黑色素瘤）。许多患者随后的PET/CT检查未发现可能涉及各种病理过程的高代谢表现，其他患者的放射性药物在葡萄膜的原发肿瘤区域被摄取。仅在体积超过0.5 cm³的黑色素瘤中发现眼球内高代谢。PET/CT检查共85次，1例患者接受了两次检查。然而，在25例患者（26次检查）中，放射性药物在随后需要密切关注的部位被摄取。检查的最初目的是定位MMU可能的转移。在其他患者中，报告了3例意外情况：肺部、肝脏、甲状腺和纵隔淋巴结代谢增加。在85次检查中，26次（30.6%）出现了不在眼内或正好在眼内的放射性药物积聚的高代谢表现。两名患者发生了两种恶性肿瘤（前列腺癌和直肠乙状结肠癌）。非常重要的是在肝脏中发现了MMU转移，这证实了PET/CT检查在MMU患者管理中的重要作用。该转移是在重复PET/CT检查后发现的。
PET/CT检查是一项技术要求较高的检查，是对体积超过0.5 cm³的眼内黑色素瘤进行成像的一种方法。在放射外科治疗前确定疾病的分级和分期以及在超声或MRI检查未给出明确结果的MMU治疗后检测可能的转移方面都很重要。然而，我们的研究证实了该项检查对于眼科医生诊断为葡萄膜黑色素瘤并将患者送去进行全身PET/CT检查的患者中随机检测到的2例双原发恶性肿瘤（2.4%）和3例偶发瘤（3.6%）的意义。
