Is 18F-FDG PET more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma?

The aim of this study was to determine the accuracy of (18)F-FDG PET in detecting recurrent melanoma. METHODS: PET findings were compared with those obtained by standard diagnostic clinical procedures (CP) to establish the role of PET in the management of patients with melanoma. From 156 patients with confirmed melanoma and recurrence suspected by clinical examination, 184 PET scans were retrospectively reviewed. Histology or clinical follow-up was used for final diagnosis. RESULTS: The sensitivity and specificity of PET for detecting lesions on an individual-patient basis were 74% and 86%, respectively, compared with respective values of 58% and 45% for CP alone. The overall accuracy for PET was 81%, compared with 52% for other methods. PET was more accurate (91% vs. 67%) than CP in detecting locoregional disease and distant metastases (85% vs. 55%), and PET results led to a change in the planned clinical management of 36% of patients included in this study. PET was more accurate than CT in detecting skin lesions, malignant lymph nodes, and metastases to the abdomen, liver, and bone. In the assessment of pulmonary disease, PET showed higher specificity (92% vs. 70%) than CT for the detection of lung parenchyma lesions; however, the sensitivity was better for CT (93%) than for PET (57%). CONCLUSION: PET is better than CP in detecting locoregional disease and distant metastases in all sites except the lung, where it appears to be a useful adjunct to CT. The use of PET as a routine clinical tool can lead to a substantial change in the clinical management of suspected recurrent melanoma.