How morphometric analysis of metastatic load predicts the (un)usefulness of PET scanning: the case of lymph node staging in melanoma
Open Access
- 1 April 2003
- journal article
- research article
- Published by BMJ in Journal of Clinical Pathology
- Vol. 56 (4) , 283-286
- https://doi.org/10.1136/jcp.56.4.283
Abstract
Background: In primary cutaneous melanoma, the sentinel node (SN) biopsy is an accurate method for the staging of the lymph nodes. Positron emission tomography (PET) has been suggested as a useful alternative. However, the sensitivity of PET may be too low to detect SN metastases, which are often small. Aim: To predict the value of PET for initial lymph node staging in melanoma based on morphometric analysis of SN metastatic load, without exposing patients to PET. Material and methods: In 59 SN positive patients with melanoma, the sizes of tumour deposits in the SNs and subsequent dissection specimens were measured by morphometry and correlated with the detection limits of current and future PET scanners. Results: The median tumour volume within the basin was 0.15 mm3 (range, 0.0001–118.86). Seventy per cent of these deposits were smaller than 1 mm3. State of the art PET scanners that have a resolution of about 5 mm would detect only 15–49% of positive basins. Logistic regression analysis revealed no pretest indicators identifying patients expected to have a positive PET. However, the SN tumour load was a significant and single predictor of the presence of PET detectable residual tumour. Conclusion: Morphometric analysis of metastatic load predicts that PET scanning is unable to detect most metastatic deposits in sentinel lymph nodes of patients with melanoma because the metastases are often small. Therefore, the SN biopsy remains the preferred method for initial regional staging.Keywords
This publication has 29 references indexed in Scilit:
- Pattern and incidence of first site recurrences following sentinel node procedure in melanoma patientsWorld Journal of Surgery, 2002
- Re: Axillary Lymph Node Staging in Breast Cancer by 2-Fluoro-2-deoxy-D-glucose-Positron Emission Tomography: Clinical Evaluation and Alternative ManagementJNCI Journal of the National Cancer Institute, 2001
- FDG–PET sensitivity for melanoma lymph node metastases is dependent on tumor volumeJournal of Surgical Oncology, 2001
- No indication for performing sentinel node biopsy in melanoma patients with a Breslow thickness of less than 0.9 mmMelanoma Research, 2001
- Comparison of Positron Emission Tomography Scanning and Sentinel Node Biopsy in the Detection of Micrometastases of Primary Cutaneous Malignant MelanomaJournal of Clinical Oncology, 2001
- Axillary Lymph Node Staging in Breast Cancer by 2-Fluoro-2-deoxy-D-glucose-Positron Emission Tomography: Clinical Evaluation and Alternative ManagementJNCI Journal of the National Cancer Institute, 2001
- PET in oncology: Will it replace the other modalities?Seminars in Nuclear Medicine, 1997
- Initial assessment of positron emission tomography for detection of nonpalpable regional lymphatic metastases in melanomaJournal of Surgical Oncology, 1997
- Potential applications of positron emission tomography in surgical oncology.1994
- Initial assessment of positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-D-glucose in the imaging of malignant melanoma.1993