A stepwise surveillance protocol bases on serial hepatic ultrasonographies (USGs) followed by confirmatory scans offers high likelihood of detecting asymptomatic metastases in patients with primary uveal melanoma, a recent study published online ahead of print in JAMA Ophthalmology has shown.1
Because there is a lack of information regarding the role of systemic surveillance in patients with primary uveal melanoma, researchers at the Cleveland Clinic Foundation in Cleveland, OH, sought to assess the utility of serial hepatic USG for detection of asymptomatic liver metastases in patients undergoing surveillance after undergoing treatment for this malignant neoplasm.
For the study, researchers analyzed data from 236 patients diagnosed with primary uveal melanoma who were treated between October 2003 and October 2012. Patients were managed using a standardized protocol consisting of periodic surveillance with hepatic USG and liver function tests every 6 months for the first 5 years and annually thereafter. Additional imaging techniques were used to confirm any hepatic USG abnormalities, and a liver biopsy was performed if the confirmatory imaging scan was positive.
Results showed that 71 patients had abnormal hepatic USGs and of the 36 patients with findings suspicious for metastasis, 64% had confirmed liver metastases.
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The sensitivity, specificity, and positive predictive value of hepatic USG for findings that were indeterminate or suspicious for metastasis were 96% (95% CI: 80-99), 88% (95% CI: 83-91), and 45% (95% CI: 33-59), respectively; however, specificity of the confirmatory scan was found to be greater than that of hepatic USG (P < .001).
- Choudhary MM, Gupta A, Bena J, et al. Hepatic ultrasonography for surveillance in patients with uveal melanoma [published online ahead of print December 3, 2015]. JAMA Ophthalmol. doi: 10.1001/jamaophthalmol.2015.4810