A review of the literature for whole-body FDG PET in the management of patients with melanoma

Background. A review and meta-analysis of the literature on the use of 2-[1 8F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the detection of recurrent melanoma was conducted. The goals were to evaluate the quality of data reporting and to determine the overall values for the s ensitivity and specificity of whole body FDG PET and management changes. Methods. Guidelines to evaluate reporting within articles were formulated b ased on the United States medical payer source criteria for assessing studi es reporting information on the utilization of new medical technology. A me ta-analysis was conducted using methodology described in the peer reviewed literature. Results. Our MEDLINE PLUS search resulted in a universe of 89 total article s. Within these 89, 19 were categorized in our targeted content area of whi ch 13 were selected for analysis in our targeted subset, with the remaining 70 covering 24 different related content areas. Five of 13 (38%) articles in the target subset reported data which was adequate for incorporation int o modeling objectives based on PET sensitivity and specificity values, with 1 of 13 (8%) in the same target subset reporting data adequate for modelin g based on change-in-management data. Through a meta-analysis of the 13 tar get articles we determined, within a 95% confidence level, an overall sensi tivity of 92% (95% confidence level 88.41%-95.82%) and an overall specifici ty of 90% (95% confidence level 83.26%-96.05%) as calculated by number of l esions, for FDG PET detecting recurrent melanoma throughout the whole body. Furthermore, limited data available for change-in-management suggests an o verall FDG PET directed change-in-management value of 22%. Conclusions. Our review suggests that improvements can be made to more effe ctively report the results of these FDG PET studies. The overall values det ermined through the meta-analysis indicate the potential benefits of using FDG PET as a diagnostic/management tool Furthermore, these values should pr ove useful to assessing the cost effectiveness of utilizing FDG PET in the management of recurrent melanoma.