ECONOMICS OF NUCLEAR MEDICINE
Guest Editor: Gambhir S. S. 

The Quarterly Journal of Nuclear Medicine 2000 June;44(2):153-67

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

A review of the literature for whole-body FDG PET in the management of patients with melanoma

Schwimmer J., Essner R. *, Patel A., Jahan S. A., Shepherd J. E., Park K., Phelps M. E., Czernin J., Gambhir S. S. **

From the Crump Institute for Biological Imaging and Department of Molecular and Medical Pharmacology The Division of Nuclear Medicine *Department of Biomathematics, UCLA School of Medicine Los Angeles, California, USA **Division of Surgical Oncology JWCI, Santa Monica, CA, USA

Background. A ­review and ­meta-anal­y­sis of the lit­er­a­ture on the use of 2-[18F]flu­o­ro-2-­deoxy-D-glu­cose (FDG) posi­tron emis­sion tomog­ra­phy (PET) in the detec­tion of recur­rent mel­a­no­ma was con­duct­ed. The ­goals ­were to eval­u­ate the qual­ity of ­data report­ing and to deter­mine the over­all val­ues for the sen­si­tiv­ity and spec­i­fic­ity of ­whole ­body FDG PET and man­age­ment chang­es. Methods. Guidelines to eval­u­ate report­ing with­in arti­cles ­were for­mu­lat­ed ­based on the United States med­i­cal pay­er ­source cri­te­ria for assess­ing stud­ies report­ing infor­ma­tion on the util­iza­tion of new med­i­cal tech­nol­o­gy. A ­meta-anal­y­sis was con­duct­ed ­using meth­o­dol­o­gy ­described in the ­peer ­reviewed lit­er­a­ture.
Results. Our MED­LINE ­PLUS ­search result­ed in a uni­verse of 89 ­total arti­cles. Within ­these 89, 19 ­were cat­e­go­rized in our tar­get­ed con­tent ­area of ­which 13 ­were select­ed for anal­y­sis in our tar­get­ed sub­set, ­with the remain­ing 70 cov­er­ing 24 dif­fer­ent relat­ed con­tent are­as. Five of 13 (38%) arti­cles in the tar­get sub­set report­ed ­data ­which was ade­quate for incor­po­ra­tion ­into mod­el­ing objec­tives ­based on PET sen­si­tiv­ity and spec­i­fic­ity val­ues, ­with 1 of 13 (8%) in the ­same tar­get sub­set report­ing ­data ade­quate for mod­el­ing ­based on ­change-in-man­age­ment ­data. Through a ­meta-anal­y­sis of the 13 tar­get arti­cles we deter­mined, with­in a 95% con­fi­dence lev­el, an over­all sen­si­tiv­ity of 92% (95% con­fi­dence lev­el 88.41%-95.82%) and an over­all spec­i­fic­ity of 90% (95% con­fi­dence lev­el 83.26%-96.05%) as cal­cu­lat­ed by num­ber of ­lesions, for FDG PET detect­ing recur­rent mel­a­no­ma through­out the ­whole ­body. Furthermore, lim­it­ed ­data avail­able for ­change-in-man­age­ment sug­gests an over­all FDG PET direct­ed ­change-in-man­age­ment val­ue of 22%.
Conclusions. Our ­review sug­gests ­that improve­ments can be ­made to ­more effec­tive­ly ­report the ­results of ­these FDG PET stud­ies. The over­all val­ues deter­mined ­through the ­meta-anal­y­sis indi­cate the poten­tial ben­e­fits of ­using FDG PET as a diag­nos­tic/man­age­ment ­tool. Furthermore, ­these val­ues ­should ­prove use­ful to assess­ing the ­cost effec­tive­ness of uti­liz­ing FDG PET in the man­age­ment of recur­rent mel­a­no­ma.