Review Value of positron emission tomography scan in stage III cutaneous melanoma: A systematic review and meta-analysis Angel M. Rodriguez Rivera a, b , Haytham Alabbas b, d , Aliya Ramjaun c, d , Ari-Nareg Meguerditchian a, b, d, * a Department of Oncology, McGill University, Montreal, QC, Canada b Department of Surgery, McGill University, Montreal, QC, Canada c Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada d Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada article info Article history: Accepted 12 January 2014 Keywords: Melanoma cutaneous malignant Fluorodeoxyglucose F18 Positron emission tomography Neoplasm metastasis abstract Purpose: The objective of this study was to review the collective experience and utility of FDG-PET scans (FDG-PET) in the detection of systemic metastases in patients with stage III melanoma. Methods: A systematic search for relevant studies published between 1990 and 2012 was performed. We included English language studies that evaluated melanoma patients with stage III disease, with at least 10 patients per study, and collected statistical data to assess FDG-PET utility in the detection of distant metastases. The SIGN tool was used to evaluate methodological quality and a meta-analysis was per- formed using Stata statistical software to quantify the clinical utility of FDG-PET. Results: The systematic search yielded 9 studies eligible for inclusion in quantitative analyses with a total of 623 patients. The overall sensitivity of FDG-PET in detecting systemic metastases was 89.42% (95% CI: 65.07e97.46), and specificity was 88.78% (95% CI: 77.04e94.91). The pooled positive likelihood ratio was 7.97 (95% CI: 3.58e17.71) and the negative likelihood ratiowas 0.12 (95% CI: 0.03e0.47). The area under the summary receiver operating curve (SROC) was 0.94 (95% CI: 0.92e0.96) and the diagnostic odds ratio (DOR) was 66.84 (95% CI: 10.66e418.89). A change in stage and/or management was noted in 22% (126/ 573) of patients when FDG-PET was utilized. Conclusions: Our findings indicate that FDG-PET may be useful in detecting distant metastases in pa- tients with stage III melanoma. For this highly selected group of patients, FDG-PET has a high sensitivity, specificity and performance, frequently leading to a change in treatment plan. Ó 2014 Elsevier Ltd. All rights reserved. Contents Introduction ......................................................................................................................... 12 Methods ........................................................................................................................... 12 Search strategy .................................................................................................................. 12 Inclusion criteria ................................................................................................................ 12 Study design ................................................................................................................. 12 Study subjects ................................................................................................................ 12 Outcomes .............................................................. ..................................................... 13 Exclusion criteria ................................................................................................................ 13 Data collection and quality assessment ............................................................................................. 13 Statistical analysis ............................................................................................................... 13 Results ............................................................................................................................. 13 Study identification and quality assessment ......................................................................................... 13 Meta-analysis of diagnostic accuracy ............................................................................................... 13 * Corresponding author. McGill University Health Centre, 687 Pine Avenue West, Room S7.30, Montreal, QC H3A 1A1, Canada. Tel.: þ1 (514) 9341934x34081; fax: þ1 (514) 843 1633. E-mail address: ari.meguerditchian@mcgill.ca (A.-N. Meguerditchian). Contents lists available at ScienceDirect Surgical Oncology journal homepage: www.elsevier.com/locate/suronc 0960-7404/$ e see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.suronc.2014.01.002 Surgical Oncology 23 (2014) 11e16