Open Access Systematic review update

F-18-fluoro-2-deoxyglucose positron emission tomography (PET) and PET/computed tomography imaging in primary staging of patients with malignant melanoma: a systematic review

Milly A Schröer-Günther1*, Robert F Wolff2, Marie E Westwood2, Fülöp J Scheibler1, Christoph Schürmann1, Brigitta G Baumert4, Stefan Sauerland1 and Jos Kleijnen23

Author Affiliations

1 Institute for Quality and Efficiency in Health Care, Im Mediapark 8, Cologne, 50670, Germany

2 Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park Riccall Road, Escrick, York, YO19 6FD, UK

3 School for Public Health and Primary Care (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht, ER, 6229, the Netherlands

4 Department of Radiation–Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Center, P.O. Box 616, Maastricht, MD, 6200, the Netherlands

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Systematic Reviews 2012, 1:62  doi:10.1186/2046-4053-1-62

Published: 13 December 2012

Abstract

Purpose

The aim of this systematic review was to systematically assess the potential patient-relevant benefit (primary aim) and diagnostic and prognostic accuracy (secondary aim) of positron emission tomography (PET) and PET/computed tomography (CT) in primary staging of malignant melanoma. This systematic review updates the previous evidence for PET(/CT) in malignant melanoma.

Materials and methods

For the first aim, randomized controlled trials (RCTs) investigating patient-relevant outcomes and comparing PET and PET(/CT) with each other or with conventional imaging were considered. For the secondary aim, a review of reviews was conducted, which was amended by an update search for primary studies. MEDLINE, EMBASE and four databases of the Cochrane Library were searched. The risk of bias was assessed using a modified QUADAS tool.

Results

No RCTs investigating the patient-relevant benefit of PET(/CT) and no prognostic accuracy studies were found. Seventeen diagnostic accuracy studies of varying quality were identified. For patients with American Joint Committee on Cancer (AJCC) stages I and II, sensitivity mostly ranged from 0 to 67%. Specificity ranged from 77 to 100%. For AJCC stages III and IV, sensitivity ranged from 68 to 87% and specificity from 92 to 98%.

Conclusion

There is currently no evidence of a patient-relevant benefit of PET(/CT) in the primary staging of malignant melanoma. RCTs investigating patient-relevant outcomes are therefore required. The diagnostic accuracy of PET(/CT) appears to increase with higher AJCC stages.

Keywords:
Positron emission tomography; Computed tomography; Staging; Recurrence; Esophageal neoplasms; Systematic review