18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Imaging in the Management of Merkel Cell Carcinoma: A Single-Institution Retrospective Study

Department of Dermatology, University of Rochester Medical Center, Rochester, New York.
Dermatologic Surgery (Impact Factor: 2.11). 06/2013; 39(9). DOI: 10.1111/dsu.12246
Source: PubMed


BACKGROUND: Merkel cell carcinoma (MCC) is among the deadliest of cutaneous malignancies. A lack of consensus evaluation and treatment guidelines has hindered management of this disease. The utility of simultaneous positron emission tomography and computed tomography (PET/CT) has been demonstrated for a variety of tumors yet remains underinvestigated for MCC. OBJECTIVES: To report the value of fluorodeoxyglucose PET/CT imaging in the initial staging and ongoing management of individuals with MCC and to determine whether any patient or tumor characteristics may predict when PET/CT is more likely to have greater influence on medical decision-making. MATERIALS AND METHODS: A single-institution retrospective chart review was conducted of all patients diagnosed with MCC who underwent FDG-PET/CT scanning from 2007 to 2010. The outcome of each of these studies was evaluated as to the influence on patient staging and management. Patient clinical information and information on gross and microscopic tumor characteristics were collected and analyzed. RESULTS: Twenty patients underwent 39 PET/CT scans. Results of PET/CT imaging revealed previously unknown information related to MCC in four (20%) patients, leading to changes in management in three of these four cases. Three previously unknown neoplasms were detected. CONCLUSION: Fluorodeoxyglucose-positron emission tomography and computed tomography is a valuable tool for initial staging and to assess response to therapy of patients diagnosed with MCC. Larger prospective studies would be required to establish the optimal timing for this imaging modality.

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    ABSTRACT: Merkel cell carcinomas (MCC) are neuroendocrine skin tumours frequently responsible for lymph node recurrence and metastatic disease and for which optimal management remains to be defined. The objective of this study was to evaluate the impact of F-fluorodeoxyglucose (F-FDG)-PET/computed tomography (CT) on the staging and treatment of MCC patients. Twenty-three patients with a histologic diagnosis of MCC explored by F-FDG-PET/CT between 2004 and 2012 were retrospectively included in the study. The detection of new lesions and the change in tumour staging and treatment were evaluated. For each patient, the F-FDG-PET/CT results were compared with histological, clinical and imaging data. Sixty-six F-FDG-PET/CT scans were performed at initial presentation (n=18), during subsequent monitoring (n=34) or during evaluation of chemotherapy response (n=14). The sensitivity, specificity and positive and negative predictive values of the F-FDG-PET/CT were 97, 89, 94 and 94%, respectively. Two false-positive results (lymphadenitis) and one false-negative result (regional metastatic lymph nodes) were accounted for. Lesions not detected clinically or by conventional imaging techniques were found in 44% of the 52 F-FDG-PET/CTs performed at initial presentation and subsequent monitoring, with, respectively, 50 and 41% of scans identifying new lesions. At initial presentation, F-FDG-PET/CT led to a change in tumour staging in 39% of patients. Patient management was modified by F-FDG-PET/CT results in one-third of patients (33% of patients at initial presentation, 32% during subsequent monitoring and 36% during evaluation of chemotherapy response). F-FDG-PET/CT incidentally detected four additional histologically confirmed cancers. This retrospective study confirms the important impact of F-FDG-PET/CT on the management of MCC patients.
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    ABSTRACT: Merkel cell carcinoma is an aggressive neuroendocrine cutaneous malignancy with a predilection for regional and distant metastasis. This malignancy presents most commonly on the head and neck of elderly Caucasian males, with a higher prevalence in the immunosuppressed. A high index of suspicion must be maintained due to the often asymptomatic presentation. Lip tumors, scalp tumors, local invasion, nodal metastasis, distant metastasis, and lymphovascular invasion are poor prognostic factors. Up to 8.7% of patients present with distant metastasis, and PET-CT is an accurate staging tool with a 90% sensitivity. Combined aggressive surgical resection with adjuvant radiotherapy affords the best regional control rates. The regional lymphatics must be addressed with either sentinel lymph node biopsy, surgery, or elective radiation due to the risk of occult metastasis. Addition of chemotherapy has no proven benefit in locoregional control.
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