The Role of Modern Methods in Early Metastases Diagnosis in Patients With Uveal
            Melanoma

Avakyan, K.V.; Saakyan, S.V.; Amiryan, A.G.; Асланиди, И. П.; Мухортова, О. В.

doi:10.21569/2222-7415-2016-6-4-8-18

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…Увеальная меланома -грозное заболевание, имеющее неблагоприятный жизненный прогноз вследствие высокого метастатического потенциала опухоли. С учетом этого раннее выявление и лечение метастатической болезни представляется весьма актуальной проблемой [1][2][3][4][5].…”

Section: Discussionunclassified

“…веальная меланома -наиболее распространенная среди взрослого населения первичная злокачественная внутриглазная опухоль с серьезным жизненным прогнозом [1][2][3]. Несмотря на успешное локальное лечение первичной увеальной меланомы, смертность пациентов вследствие развития метастатической болезни остается высокой [1,4,5].…”

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“…Для ранней диагностики метастатической болезни при увеальной меланоме и мониторинга больных наиболее широкое применение получили ультразвуковое исследование (УЗИ) органов брюшной полости и рентгенография органов грудной клетки [3,[6][7][8][9]. Однако ряд исследований показали, что в обнаружении метастатической увеальной меланомы эти скрининговые методы обладают высокой специфичностью, но низкой чувствительностью [4,6,8,10].…”

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“…Как известно, при развитии заболевания функциональные изменения предшествуют появлению структурных нарушений [11,12]. В связи с этим в последние десятилетия все большее распространение в клинической практике приобретает метод радионуклидной диагностики, основанный на принципах молекулярной визуализации, -позитронно-эмиссионная томография (ПЭТ), совмещенная с компьютерной томографией (КТ; ПЭТ/КТ) [4,6]. С ее помощью можно одновременно оценивать метаболические (по данным ПЭТ) и структурные (по данным КТ) изменения в органах и тканях, благодаря чему заболевания выявляют на более ранних стадиях по сравнению с методами структурной визуализации (рентгенография, УЗИ, КТ) [3,[6][7][8][9][10]13].…”

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Polyneoplasias in uveal melanoma patients detected by positron emission tomography combined with computed tomography (two clinical cases)

Avakyan¹,

Saakyan²,

Amiryan³

et al. 2017

Alʹm. klin. med.

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Section: Discussionunclassified

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Polyneoplasias in uveal melanoma patients detected by positron emission tomography combined with computed tomography (two clinical cases)

Avakyan¹,

Saakyan²,

Amiryan³

et al. 2017

Alʹm. klin. med.

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“…Во всем мире существует большой интерес к разработке новых методов диагностики и лечения пациентов с метастатической УМ, в базе PubMed находятся более 1000 зарубежных источников, которые посвящены этой проблеме. В России лишь в единичных работах уделяется внимание теме метастатической УМ [22,23].…”

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The diagnosis of metastatic uveal melanoma. What has changed during 10 years?

2020

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Uveal melanoma is the most common intraocular malignancy. Despite significant progress in the treatment of the primary tumor, uveal melanoma continues to be the most aggressive tumor due to its high potential for hematogenous metastatic spread. Uveal melanoma metastases are located mostly in the liver. Overall survival of patients with liver metastases is 4 to 15 months. There is no adjuvant systemic therapy to prevent metastases of uveal melanoma. In this paper, we aim to analyze achievement in diagnosis of metastatic uveal melanoma made during the last 10 years and to show advantages and disadvantages of the main diagnostic methods. The last years showed the emergence of understanding the differences between skin and uveal melanoma based on different molecular genetic abnormalities and different signaling pathways of these tumors. The success of target treatments for skin melanoma is not applicable to uveal melanoma. Skin and uveal melanoma responds differently to immune checkpoint inhibitors. Insufficient efficacy of systemic chemotherapy, immune and target therapy has made it necessary to develop techniques of local chemoembolization and radioembolization of uveal melanoma metastases. At present, there are no available assessment algorithms for the management of patients with uveal melanoma and suspected metastases. Ultrasonography, if seen as available techniques for radiology diagnostics, should be enhanced either by the intravenous contrast, or by qualifying computed tomography. The use of positron emission tomography / computed tomography has not demonstrated the maximal diagnostic value in identification of liver metastases, and, taken into account its high costs, low availability, and large radiation dose, it cannot be considered as a feasible method for every 6 months' application. The most effective diagnostic method is magnetic resonance imaging with the liver-specific contrast agents, due to the possibility to detect metastases of less than 1 cm in diameter. However, this technique has not been widely accepted clinically due to high costs, contraindications and a big proportion of false positive results. Current armamentarium of radiation techniques that could be potentially applicable for visualization of hepatic focal abnormalities is rather impressive and is being continuously updated; however, the problem of the metastatic uveal melanoma diagnosis remains unsolved.

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Patients presenting with metastases: stage IV uveal melanoma, an international study

et al. 2021

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ObjectiveTo analyse ocular and systemic findings of patients presenting with systemic metastasis.Methods and analysisIt is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.ResultsOf 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1–T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.ConclusionsThough higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.

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The Role of Modern Methods in Early Metastases Diagnosis in Patients With Uveal Melanoma

Cited by 5 publications

References 10 publications

Polyneoplasias in uveal melanoma patients detected by positron emission tomography combined with computed tomography (two clinical cases)

Polyneoplasias in uveal melanoma patients detected by positron emission tomography combined with computed tomography (two clinical cases)

The diagnosis of metastatic uveal melanoma. What has changed during 10 years?

Patients presenting with metastases: stage IV uveal melanoma, an international study

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