Diagnostic accuracy of imaging studies for initial staging of T2b to T4b melanoma patients: A cross-sectional study - 11/10/19

Doi : 10.1016/j.jaad.2019.05.076

Constanza Riquelme-Mc Loughlin, MD ^a, Sebastian Podlipnik, MD ^a,^b, Xavier Bosch-Amate, MD ^a, José Riera-Monroig, MD ^a, Alicia Barreiro, MD ^a,^b, Natalia Espinosa, MD ^a,^b, David Moreno-Ramírez, MD, PhD ^a, Priscila Giavedoni, MD ^a, Ramon Vilana, MD ^b,^c, Marcelo Sánchez, MD ^c, Sergi Vidal-Sicart, MD, PhD ^b,^d, Cristina Carrera, MD, PhD ^a,^b,^e, Josep Malvehy, MD, PhD ^a,^b,^e, Susana Puig, MD, PhD ^a,^b,^e,^⁎
^a Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
^b Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
^c Radiology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
^d Nuclear Medicine Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
^e Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain

^∗Correspondence to: Susana Puig, MD, PhD, Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain.Melanoma UnitDermatology DepartmentHospital Clinic BarcelonaVillarroel 170Barcelona08036Spain

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Abstract

Background

There is no consensus on the imaging tests that should be performed at the initial staging of melanoma patients.

Objective

To evaluate the diagnostic accuracy of 4 imaging studies for the initial staging of melanoma patients.

Methods

Cross-sectional study with prospectively collected data, from January 2011 to April 2017, including patients with clinical stage T2b to T4b according to 2009 American Joint Committee on Cancer, without evidence of metastasis.

Results

Initial staging of 308 patients detected 16.6% of metastases and 5.8% false-positive results, overall. Regional lymph node ultrasonography showed a metastasis detection rate (MDR) of 12.8%, false-positive rate of 0.8%, and accuracy of 96.0%. Computed tomography (CT) and positron emission tomography-CT had the highest detection rates at stage T4b: MDR, 13.3%; false-positive rate, 8.9%; accuracy, 91.1%; and MDR, 6.9%; false-positive rate, 0%; and accuracy, 93.1%, respectively. Brain magnetic resonance imaging showed a MDR of 2.0% in T4b.

Limitations

Single-center study.

Conclusion

Performing ultrasound scans for assessing lymph node metastasis in patients with American Joint Committee on Cancer T2b stage and above is advisable. In patients with stage T4b, CT or positron emission tomography-CT are suitable for the detection of metastasis. Brain magnetic resonance imaging at T4b deserves further discussion, considering the ultimate clinical benefit in management and therapeutic options for asymptomatic patients.

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Key words : clinical decision making, computed tomography, diagnostic tests, magnetic resonance imaging, melanoma, metastasis, positron emission tomography, prognosis, staging, ultrasonography

Abbreviations used : CT, FPR, MRI, MDR, PET-CT, PPV

Plan

	Drs Riquelme-Mc Loughlin and Podlipnik contributed equally to this article.
	Funding sources: The study in the Melanoma Unit, Hospital Clínic, Barcelona, was partly supported by grants from Fondo de Investigaciones Sanitarias PI 12/00840, PI 15/00956, and PI 15/00716 Spain; by the Centro de Investigación Biomédica en Red de Enfermedades Raras of the Instituto de Salud Carlos III, Spain, cofunded by “Fondo Europeo de Desarrollo Regional (FEDER), Unión Europea, Una manera de hacer Europa”; by the Agency for Management of University and Research Grants (AGAUR) 2014_SGR_603 and 2017_SGR_1134 of the Catalan Government, Spain; by a grant from “Fundació La Marató de TV3, 201331-30,” Catalonia, Spain; by the European Commission under the 6th Framework Programme, Contract No. LSHC-CT-2006-018702 (GenoMEL); by Centres de Recerca de Catalunya (CERCA) Programme/Generalitat de Catalunya; by a research grant from “Fundación Científica de la Asociación Española Contra el Cáncer” GCB15152978SOEN, Spain; and by a grant from the European Academy of Dermatology and Venereology (EADV) (PPRC-2017/19). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, approval of the manuscript, or in the decision to submit the manuscript for publication.
	Conflicts of interest: None disclosed.
	Reprints not available from the authors.