Practical Considerations When Interpreting FDG PET/CT Imaging for Staging and Treatment Response Assessment in Melanoma Patients

Wiele, Christophe Van de; Juanito, Gebreurs; Vander, Borght K.; Lawal, Ismaheel; Sathekge, Mike; Maes, Alex; Spiegeleer, Bart De

doi:10.1053/j.semnuclmed.2021.06.010

Cited by 8 publications

(7 citation statements)

References 75 publications

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“…The decreased glucose uptake with increased lactate production may be due to a different energy source the resistant cell lines utilize besides glucose (e.g., glutaminolysis, lipolysis, etc.). As an aside, these results could explain, at least in part, the difficulties of predicting response by positron emission tomography (PET) [35][36][37]. PET is the modality for staging patients with solid malignancies, including melanoma [37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Metabolic Imaging Biomarkers for MEK Inhibition Therapy Response in Melanoma

Gupta,

Orlovskiy,

Arias-Mendoza

et al. 2024

Preprint

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The MAPK signaling pathway with BRAF mutations has been shown to drive the pathogenesis of 40-60% of melanomas. Inhibitors of this pathway's BRAF and MEK components are currently used to treat these malignancies. However, responses to these treatments are not always successful. Therefore, identifying noninvasive biomarkers to predict treatment responses is essential for personalized medicine of melanoma patients. Using noninvasive 1H magnetic resonance spectroscopy (1H MRS), we previously showed that BRAF inhibition reduces lactate and alanine tumor levels at early stages of effective therapy and could be construed as metabolic imaging biomarkers for drug response. The present work aimed to demonstrate if these metabolic changes and those assessed by 31P MRS are also found in preclinical human melanoma models treated with MEK inhibitors. Apart from 1H and 31P MRS, additional supporting in vitro biochemical analyses are described. Our results indicate significant early metabolic correlations with response levels to MEK inhibition in the melanoma models and are consistent with our previous study of BRAF inhibition. Given these results, our study supports the potential clinical utility of noninvasive MRS to objectively image metabolic biomarkers for early predicting melanoma response to MEK inhibition.

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Section: Discussionmentioning

confidence: 99%

Assessment of Metabolic Imaging Biomarkers for MEK Inhibition Therapy Response in Melanoma

Gupta,

Orlovskiy,

Arias-Mendoza

et al. 2024

Preprint

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“…Due to the low risk of distant metastases and PET camera resolution limitations for detecting microscopic nodal disease, [18F]FDG PET/CT plays a limited role in staging early melanoma (AJCC stages I and II) (5,6). Conversely, [18F]FDG PET/CT has value in the initial staging of advanced cutaneous melanoma (AJCC stages III and IV), where it demonstrates a high accuracy in the detection of lymph node, soft tissue, and visceral metastases (8).…”

Section: Normal Variants and Pitfalls In Staging And Disease Recurrencementioning

confidence: 99%

“…positive disease (stage III) and advanced or metastatic disease (stage IV) (4,5). The key clinical and pathological features that impact melanoma staging are tumor thickness (known as the Breslow depth), ulceration, rate of mitosis, presence of microsatellites nodes and in-transit lesions, tumor status of regional lymph nodes and presence of distant metastasis (2).…”

Section: Introductionmentioning

confidence: 99%

“…The clinical relevance of hybrid [18F]FDG PET/CT imaging is in the staging and re-staging of high risk melanoma (AJCC Stages III and IV), where there is good sensitivity and specificity for identifying additional disease sites (5,6). The valuable performance of [18F]FDG PET/CT is wellestablished in N-and M-staging of cutaneous melanoma at different phases of diagnosis that include primary staging, response assessment post-chemotherapy, staging of suspected recurrence and in determining prognosis (7).…”

Section: Introductionmentioning

confidence: 99%

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F-18 Fluoro-2-Deoxyglucose Positron Emission Tomography (PET)/Computed Tomography (CT) Imaging in Melanoma: Normal Variants, Pitfalls, and Artifacts

Momodu

Vangu

2022

Front. Nucl. Med.

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Multimodality imaging has revolutionized diagnostic imaging for several oncologic pathologies including melanoma. Although F-18 fluoro-2-deoxyglucose positron emission tomography/ computed tomography [18F]FDG PET/CT has a high sensitivity in stage III and IV melanoma, several normal variants, and imaging pitfalls may result in falsely increased or reduced tracer uptake that may negatively impact diagnostic accuracy. In addition to normal physiologic tracer uptake, differences in the biological and molecular characteristics of different types of melanoma are also responsible for pitfalls. For instance, [18F]FDG PET/CT has a low sensitivity for detecting brain metastases due to normal physiologic [18F]FDG uptake in brain tissue while hepatic metastases from cutaneous melanoma are more [18F]FDG-avid than hepatic metastases from uveal melanoma. With the introduction of immunotherapies for melanoma, treatment response assessment using [18F]FDG PET/CT has a reduced specificity. This is due to hypermetabolic immune-related adverse effects such as hepatitis, dermatitis, and colitis resulting in false-positive uptake. In addition, immune therapy-induced initial increase in tumor uptake followed by disease response (pseudo-progression) is a cause of false-positive scan interpretation. Specific technical artifacts impact disease detection in [18F]FDG PET/CT melanoma imaging. The identification of small metastatic lymph nodes and lung nodules may be limited by the resolution of the PET/CT camera (partial volume effect). Computed tomography (CT) attenuation correction results in less apparent skin and subcutaneous lesions. Pictorial illustrations will be central to this paper for the description of these normal variants, imaging artifacts, and pitfalls. It is critical for the imaging specialist to have a clear understanding of these potential limitations of 18F-FDG PET/CT imaging in individuals who are referred with melanoma.

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“…The virtue of PET-CT in detecting metastases from malignant melanoma is illustrated in Figure 3 . Moreover, FDG PET/CT can be used in order to assess treatment response [ 44 ] by evaluating the outcome as influenced by immunotherapy. When looking [ 45 ] at the compared efficacy of ultrasound, MRI, CT scan, and PET-CT scan, PET-CT exam registered the best results, both of which concern staging and re-staging of the disease.…”

Section: Main Findings Of the Literature (Review) Questmentioning

confidence: 99%

Intra-Abdominal Malignant Melanoma: Challenging Aspects of Epidemiology, Clinical and Paraclinical Diagnosis and Optimal Treatment—A Literature Review

et al. 2022

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According to European consensus-based interdisciplinary guidelines for melanoma, cutaneous melanoma (CM) is the most deadly form of dermatological malignancy, accounting for 90% of the deaths of skin cancer patients. In addition to cutaneous melanoma, mucosal melanoma occurs in four major anatomical sites, including the upper respiratory tract, the conjunctiva, the anorectal region, and the urogenital area. As this cancer type metastasizes, a classification used in the current medical literature is the distinction between secondary lesions and primary malignant melanoma of the abdominal cavity. Given that malignant melanoma is the most common cancer that spreads to the gastrointestinal tract, different imaging modalities compete to diagnose the phenomenon correctly and to measure its extension. Treatment is primarily surgery-based, supported by immunotherapy, and prolongs survival, even when performed at stage IV illness. In the end, special forms of malignant melanoma are discussed, such as melanoma of the genito-urinary tract and amelanotic/achromic melanoma. The importance of this present literature review relies on yielding and grouping consistent and relevant, updated information on the many aspects and challenges that a clinician might encounter during the diagnosis and treatment of a patient with intra-abdominal melanoma.

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Practical Considerations When Interpreting FDG PET/CT Imaging for Staging and Treatment Response Assessment in Melanoma Patients

Cited by 8 publications

References 75 publications

Assessment of Metabolic Imaging Biomarkers for MEK Inhibition Therapy Response in Melanoma

Assessment of Metabolic Imaging Biomarkers for MEK Inhibition Therapy Response in Melanoma

F-18 Fluoro-2-Deoxyglucose Positron Emission Tomography (PET)/Computed Tomography (CT) Imaging in Melanoma: Normal Variants, Pitfalls, and Artifacts

Intra-Abdominal Malignant Melanoma: Challenging Aspects of Epidemiology, Clinical and Paraclinical Diagnosis and Optimal Treatment—A Literature Review

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