Accuracy of PET/CT in the diagnosis of pelvic lymph node metastases in melanoma: A subgroup analysis of the prospective, randomised, phase III Evaluation of groin lymphadenectomy extent for metastatic melanoma (EAGLE-FM) trial

Michael Russell¹, Louise Emmett², Barbara Peric³, Robyn Pm Saw⁴, John Spillane⁵, Vinicius Vasquez⁶, Joao Duprat⁷, Marc Moncrieff⁸, Chris Allan⁹, Barbara van Leeuwen¹⁰, Rowan Pritchard-Jones¹¹, Marco Rastrelli¹², Johannes de Wilt¹³, Eduardo Bertolli⁷, Antonio Sommariva¹², Jenny Geh¹⁴, Julie Howle¹⁵, Andrew Spillane¹⁶

Affiliations

¹ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia. Electronic address: michael.russell@waitematadhb.govt.nz.
² Department of Theranostics and Nuclear Medicine, St Vincent's Hosptial, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia.
³ Institute of Oncology Ljubljana, Medical Faculty, University of Ljubljana, Slovenia.
⁴ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Peter MacCallum Cancer Centre, Department of Surgical Oncology, Melbourne, Australia.
⁶ Hospital de Cancer de Barretos, Brazil.
⁷ AC Camargo Cancer Center, Brazil.
⁸ Norfolk & Norwich University Hospital, Plastic and Reconstructive Surgery, United Kingdom.
⁹ Mater Clinic School, Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹⁰ University Medical Center Groningen, Surgical Oncology, the Netherlands.
¹¹ Saint Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Knowsley, United Kingdom.
¹² Veneto Institute of Oncology, Surgical Oncology, Padova, Italy.
¹³ Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands.
¹⁴ Guy's and St. Thomas' NHS Foundation Trust, Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, London, United Kingdom.
¹⁵ Westmead Hospital, Sydney, Australia.
¹⁶ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia.

PMID: 41240797
DOI: 10.1016/j.ejso.2025.111163

Accuracy of PET/CT in the diagnosis of pelvic lymph node metastases in melanoma: A subgroup analysis of the prospective, randomised, phase III Evaluation of groin lymphadenectomy extent for metastatic melanoma (EAGLE-FM) trial

Michael Russell et al. Eur J Surg Oncol. 2025.

. 2025 Nov 12;52(1):111163.

doi: 10.1016/j.ejso.2025.111163. Online ahead of print.

Authors

Affiliations

¹ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia. Electronic address: michael.russell@waitematadhb.govt.nz.
² Department of Theranostics and Nuclear Medicine, St Vincent's Hosptial, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia.
³ Institute of Oncology Ljubljana, Medical Faculty, University of Ljubljana, Slovenia.
⁴ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Peter MacCallum Cancer Centre, Department of Surgical Oncology, Melbourne, Australia.
⁶ Hospital de Cancer de Barretos, Brazil.
⁷ AC Camargo Cancer Center, Brazil.
⁸ Norfolk & Norwich University Hospital, Plastic and Reconstructive Surgery, United Kingdom.
⁹ Mater Clinic School, Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹⁰ University Medical Center Groningen, Surgical Oncology, the Netherlands.
¹¹ Saint Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Knowsley, United Kingdom.
¹² Veneto Institute of Oncology, Surgical Oncology, Padova, Italy.
¹³ Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands.
¹⁴ Guy's and St. Thomas' NHS Foundation Trust, Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, London, United Kingdom.
¹⁵ Westmead Hospital, Sydney, Australia.
¹⁶ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Mater Hospital Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia.

PMID: 41240797
DOI: 10.1016/j.ejso.2025.111163

Abstract

Background: PET/CT is widely used in the staging of patients with melanoma groin lymph node (LN) metastases. This study aims to utilise prospectively collected data to determine the accuracy of this modality in the diagnosis of pelvic metastases in those patients with known inguinal LN involvement.

Methods: Data collected as part of the Evaluation of Groin Lymphadenectomy Extent for Metastatic Melanoma (EAGLE-FM) trial was analysed. Patients with known inguinal LN metastases were evaluated with 18 F-FDG PET/CT. Those without evidence of pelvic LN abnormalities were randomised to inguinal dissection or ilio-inguinal dissection. Those with evidence of abnormality in the pelvic LNs were excluded from the main EAGLE-FM trial but offered ilio-inguinal dissection. Post operative histology results from those patients undergoing ilio-inguinal dissection were analysed to determine the accuracy of PET/CT in the assessment of pelvic LNs.

Results: There were 101 patients randomised on the EAGLE-FM trial. For this substudy, there were 49 patients who had negative pelvic LNs on PET/CT and 5 patients with positive pelvic nodes on PET/CT included in this analysis. The sensitivity of PET/CT was 25 %, specificity 95.6 % with positive predictive value (PPV) 50.0 % and negative predictive value (NPV) 87.8 %.

Conclusion: PET/CT has reasonable NPV but poor PPV. While PET/CT is an important modality in the staging of patients with stage III melanoma, it has limited accuracy in the diagnosis of pelvic LN metastases.

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Conflict of interest statement

Declarations of interest Barbara van Leeuwen is an Associate Editor for YEJSO and had no involvement in the peer-review of this article, and has no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to another journal editor. Robyn PM Saw received honoraria for advisory board participation from MSD, Novartis and Qbiotics, and speaking honoraria from BMS and Novartis.

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Accuracy of PET/CT in the diagnosis of pelvic lymph node metastases in melanoma: A subgroup analysis of the prospective, randomised, phase III Evaluation of groin lymphadenectomy extent for metastatic melanoma (EAGLE-FM) trial

Affiliations

Accuracy of PET/CT in the diagnosis of pelvic lymph node metastases in melanoma: A subgroup analysis of the prospective, randomised, phase III Evaluation of groin lymphadenectomy extent for metastatic melanoma (EAGLE-FM) trial

Authors

Affiliations

Abstract

Conflict of interest statement

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