Retrospective analysis of melanoma patients who had PET-CT examination

Background and Design: The incidence of melanoma is increasing significantly in Turkey as it is in the whole world. Thus, Positron Emission Tomography-Computed Tomography (PET-CT), which is being reimbursed by the government for the documentation of metastases of clinically suspicious patients with stages 1 b and higher, is becoming widely used. This study aims to analyze, the histopathological features of the tumors and the clinical and demographical data of the melanoma patients whom of which had PET-CT examination for the screening of metastases. Material and Methods: Study collected data of 57 melanoma patients who have underwent PET-CT evaluation in the Nuclear Department Unit, between the years of 2004-2011. On the basis of PET-CT positivity, SUV(Standard uptake value), demographical data, Breslow thickness, localization of the primary tumor, the presence of histopathologically documented ulceration, perineural, vascular and lymphatic invasion, metastases detected by other screening methods and the proposed treatment methods have been retrospectively analyzed. Results: Data collected showed PET-CT positivity in 22(39%) patients. The mean Breslow thickness was 5.12±6.29mm. Accordingly, n: 1(%7), with ≤1mm, n: 5(36%) with 2-4mm and n: 8(57%) with >4mm of Breslow thickness, had distant metastases. Statistically significant correlation was found between Breslow thickness and PET-CT positivity. The distribution of the primary tumor site was 35,3% left-sided, 25,5% right-sided and 39,2% on the midline. All patients with scalp involvement had distant metastases. No statistically significant correlation was found between PET-CT positivity and histopathologically proven ulceration, perineural, vascular and lymphatic invasion respectively. Thirty one percent positive correlation was found between Breslow thickness and SUV. Forty-five percent of PET-CT positive patients also had their metastases documented with other screening methods. All but 2 patients with distant metastases had wide tumor resection and adjuvant chemotherapy or radiotherapy.Conclusion: Complementing PET-CT to conventional imaging methods, gains much importance in the treatment planning of some selected high risk melanoma patients.

PET–BT incelenmesi yapýlan melanom hastalarýnýn retrospektif analizi

Giriþ ve Amaç: Tüm dünyada olduðu gibi ülkemizde de melanom insidansý hýzla artmaktadýr. Evre 1b ve üzeri olan melanom hastalarýnda, metastaz taramasý için devlet tarafýndan geri ödemesi yapýlan Pozitron Emisyon Tomografisi-Bilgisayarlý Tomografi (PET-BT) görüntüleme tekniðinin kullanýmý da giderek yaygýnlaþmýþtýr. Bu çalýþmada PET-BT incelenmesi yapýlmýþ melanom hastalarýnýn, demografik verileri, klinik bulgularý ve tümörlerinin histopatolojik özellikleri araþtýrýlmýþtýr.
Gereç ve Yöntem: Çalýþmaya, 2004-2011 yýllarý arasýnda, Nükleer Týp bölümünde PET-BT incelenmesi yapýlan 57 melanom hastasýnýn kayýtlý verileri alýnmýþtýr. Hastalarda, PET-BT pozitifliði esas alýnarak, SUV (Standart tutulum deðeri), demografik özellikler, Breslow kalýnlýðý, birincil tümörün tutulum bölgesi, histopatolojik olarak ülserasyon, perinöral, damar ve lenfatik invazyon varlýðý, diðer görüntüleme tekniklerinin pozitifliði ile uygulanmýþ olan tedavi yöntemleri, retrospektif olarak deðerlendirilmiþtir.
Bulgular: Toplanan verilere göre, PET-BT pozitifliði 21 hastada (%37,5) saptanmýþtýr. Ortalama Breslow kalýnlýðý 5.12±6.29 mm olarak bulunmuþtur. Buna göre Breslow kalýnlýðý raporlanmýþ hastalar arasýnda, ≤1mm olan n: 1 (%7), 2-4 mm arasý olan n: 5 (%36) ve >4 mm olan n: 8 (%57) hastada PET-BT pozitifliði görülmüþtür. Breslow kalýnlýðý ile PET-BT pozitifliði arasýnda istatistiksel açýdan anlamlý bir iliþki saptanmýþtýr. Primer tümörlerin vücut tutulum bölgelerine göre daðýlýmý ise, %35,3ü gövdenin sol yarýsý, %25,5’i gövdenin sað yarýsý ve %39,2’si ise orta hat kökenli olacak þekilde bulunmuþtur. Saçlý deri tutulumu olan hastalarýn hepsinde PET-BT ile uzak metastaz saptanmýþtýr. Ülserasyon, perinöral, damar ve lenfatik invazyon varlýðý ile PET-BT pozitifliðý arasýnda anlamlý bir iliþki saptanmamýþtýr. Breslow kalýnlýðý ile SUV deðerleri arasýnda %31’lik pozitif korelasyon bulunmuþtur. PET-BT ile metastaz saptanan hastalarýn %45’inde diðer görüntüleme yöntemleri ile de belirlenmiþ metastaz bulgularý mevcuttur. Uzak metastazý olan hastalarýn 2’si hariç hepsine geniþ eksizyon ve adjuvan kemoterapi veya radyoterapi tedavi uygulanmýþtýr. 
Sonuç: Yüksek risk grubundaki olgularýn bir kýsmýnda, tedavi planýnýn oluþturulmasýnda, konvansiyonel görüntüleme yöntemlerine ilave olarak, PET- BT uygulamasýnýn, önemli bir yeri olduðunu düþünmekteyiz.