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. 2020 Apr;82(4):878-886.
doi: 10.1016/j.jaad.2019.09.035. Epub 2019 Sep 25.

Restaging [18F] fludeoxyglucose positron emission tomography/computed tomography scan in recurrent cutaneous squamous cell carcinoma: Diagnostic performance and prognostic significance

Sonia Mahajan  1 , Christopher A Barker  2 , Audrey Mauguen  3 , Bhuvanesh Singh  4 , Neeta Pandit-Taskar  5
Affiliations

Restaging [18F] fludeoxyglucose positron emission tomography/computed tomography scan in recurrent cutaneous squamous cell carcinoma: Diagnostic performance and prognostic significance

Sonia Mahajan et al. J Am Acad Dermatol. 2020 Apr.

Abstract

Background: There are no specific recommendations for [18F] fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in assessing recurrent cutaneous squamous cell carcinoma (cSCC).

Objective: To evaluate FDG-PET/CT in recurrent cSCC.

Methods: FDG-PET/CT scans were retrospectively reviewed. Sites of abnormal uptake were noted and correlated with biopsy/histopathology studies, where available, and with follow-up imaging or clinical data in others. Comparison with available CT/magnetic resonance imaging was performed. The prognostic significance of PET/CT parameters was evaluated, and PET/CT-based change in management was recorded.

Results: A total of 115 FDG-PET/CT scans were analyzed in 100 consecutive patients with cSCC. Of these, 96 (84%) scans were positive for recurrence, and 25 showed distant metastases. PET/CT detected unsuspected disease sites in 39 of 115 scans (34%), locoregional disease in 14, distant metastases in 11, both locoregional disease and distant metastases in 8, additional local cutaneous disease in 5, and second malignancy in 1. Comparison of 78 PET/CT scans with available CT/magnetic resonance imaging showed 37 additional abnormalities on 23 PET/CT scans, predominantly including skin/subcutaneous lesions and nodes. PET/CT led to change in management in 28% of patients. On univariate/multivariate analysis, increased number of FDG-positive lesions and lung metastases on PET/CT was associated with increased risk of death/disease progression.

Limitations: Retrospective study.

Conclusions: FDG-PET/CT was sensitive in detecting recurrent disease in cSCC, led to change in management for 28% of patients, and proved to be of prognostic value.

Keywords: FDG-PET/CT; cutaneous; neoplasm; oncology; positron emission tomography; prognosis; recurrent; restaging; squamous cell carcinoma.

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Conflict of interest statement

Conflicts of Interest: There are no relevant conflicts of interest. SM, AM, and BS have no financial disclosures. NPT has served as a consultant to Y-mAbs Therapeutics, Inc., and has served on the advisory board of Progenics. NPT has received honoraria from Progenics and MedImmune/AstraZeneca and has conducted funded research studies with ImaginAb. CB reports grants from Amgen, Elekta, and Merck outside the submitted work.

Figures

Figure 1.
Figure 1.
A 75-year-old man with primary cSCC of scalp presented with swelling in right parotid gland, suspicious for recurrence and underwent FDG-PET/CT scan. Maximal intensity projection images demonstrated avidity in right parotid node measuring 1.2 × 1.0 cm (thick arrow, SUV 9) with unsuspected additional FDG-avid disease sites including multiple scalp lesions (thin black arrows), and right axillary lymph node measuring 1.5 × 0.8 cm (dashed arrow, SUV 10.8).
Figure 2.
Figure 2.
Prognostic stratification of FDG-PET/CT positivity using Kaplan Meier curves. (A) time to progression; (B) overall survival.
See this image and copyright information in PMC

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