Abstract
BackgroundOver the past several years the incidence of cutaneous melanoma has rapidly increased. This tumor develops often in-transit metastases that significantly reduce patient survival at 5 years. To improve prognosis and quality of life in patients with melanoma metastases, a mini invasive procedure like electrochemotherapy (ECT) is adopted to remove superficial tissue lesions. To detect the melanoma metastases, high frequency (HF) ultrasound (US) is used. This technique, though, can be time-consuming and it needs an expert operator and a high performing machine. Therefore, we asked whether the US could be replaced or integrated with other less time-consuming techniques such as 18-FDG positron emission tomography/computed tomography (PET-CT) and telethermography (TT).MethodsFifteen patients (4 males and 11 females - age range: 63–91) affected whit advanced stage melanoma were enrolled. They presented 52 in-transit metastases as detected by the three techniques used, HF-US, PET/CT and TT within 30 days before ECT.ResultsAll the 52 lesions were detected by HF-US (100%), 24/52 were detected by PET-CT (42,6%) and 15/52 were detected by TT (27,7%). PET-CT reported 3.7% false positives, while no false positive were reported by TT.ConclusionsAs US detected 100% lesions, compared to the other two techniques used, US, along with clinical examination, has still to be considered as gold standard in the diagnosis of metastatic lesions. US, associated with an exhaustive anamnesis and accurate clinical examination, cannot be replaced by either PET-CT or TT. When US performing devices and experienced operators are not available, though, it is highly recommended to integrate US with at least one of the other techniques. Under certain circumstances, as in the case of obese and non-collaborating patients or in patients with lymphatic stasis, these techniques should be integrated to obtain exact in-transit metastases evaluation.
Highlights
Over the past several years the incidence of cutaneous melanoma has rapidly increased with about 60,000 new cases diagnosed every year in Europe [1,2,3]
US enabled to detect 52 lesions; positron emission tomography/computed tomography (PET-CT) detected lesions; TT identified 15 lesions (Table 2)
We found that 32 out of a total of 52 lesions (61.5%) were visualized only by the instruments since they were not clearly evident on clinical examination
Summary
Over the past several years the incidence of cutaneous melanoma has rapidly increased (incidence ranging from 2 to 20%) with about 60,000 new cases diagnosed every year in Europe [1,2,3]. It is important to evaluate whether other available techniques might have good sensitivity for detecting melanoma metastases in patients eligible for ECT, in order to replace or integrate US with other less time-consuming imaging techniques. In this respect, positron emission tomography/computed tomography (PET-CT) and telethermography (TT) can be considered useful to overcome these limitations and to obtain adequate diagnostic results. We asked whether the US could be replaced or integrated with other less time-consuming techniques such as 18-FDG positron emission tomography/computed tomography (PET-CT) and telethermography (TT)
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