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PET-CT underestimates the true pathological extent of disease at lymphadenectomy for melanoma patients after systemic therapy. | LitMetric

AI Article Synopsis

  • Modern systemic therapy has changed the landscape of melanoma treatment, with lymphadenectomy often still required for patients with involved lymph nodes, bringing potential complications.
  • A study reviewed 39 patients who had lymphadenectomy after systemic therapy and a preoperative PET-CT, comparing their PET-CT findings to actual pathological outcomes.
  • Results showed that in 30% of cases, PET-CT underestimated the disease's extent, and no reliable predictors for more extensive disease were found, highlighting the risks of relying solely on PET-CT for treatment decisions.

Article Abstract

Introduction: Modern systemic therapy has revolutionized the treatment of melanoma. Currently, patients with clinically involved lymph nodes require lymphadenectomy with associated morbidities. Positron Emission Tomography - Computed Tomography (PET-CT) has demonstrated accuracy in melanoma detection and response to therapy. We aimed to identify whether a PET-CT directed lymphatic resection after systemic therapy is oncologically sound.

Materials And Methods: Retrospective review of patients who underwent lymphadenectomy after systemic therapy for melanoma with a preoperative PET-CT. Examined demographic, clinical, and perioperative parameters including extent of disease, systemic therapy and response, and PET-CT findings compared to pathological outcomes. We compared patients with "as or less than expected" outcomes on pathology against those with "more than expected" pathological outcomes.

Results: Thirty-nine patients met inclusion criteria. In 28 (71.8%), pathological outcomes were "as or less than expected" by PET-CT, and in 11 (28.2%) pathological outcome were "more than expected". "More than expected" occurred more frequently with advanced disease at presentation with 75% presenting with regional/metastatic disease versus only 42.9% in the "as or less than expected" group (p = 0.015). Poor response to therapy also trended towards the "more than expected" group with only 27.3% favorable response versus 53.6% favorable response in the "as or less than expected" group, not statistically significant. Extent of disease on imaging failed to predict pathological concordance.

Conclusion: PET-CT underestimates pathological extent of disease in the lymphatic basin in 30% of patients after systemic therapy. We failed to identify predictors of more extensive disease and warn against limited PET-CT directed lymphatic resections.

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Source
http://dx.doi.org/10.1016/j.ejso.2023.06.002DOI Listing

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