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Clinical Sciences |

Hepatic Abnormalities Identified on Abdominal Computed Tomography at Diagnosis of Uveal Melanoma FREE

Eric G. Feinstein, BS; Brian P. Marr, MD; Corinne B. Winston, MD; David H. Abramson, MD
[+] Author Affiliations

Author Affiliations: University of Virginia School of Medicine, Charlottesville (Mr Feinstein); and Ophthalmic Oncology Service (Drs Marr and Abramson) and Department of Radiology (Dr Winston), Memorial Sloan-Kettering Cancer Center, New York, New York.


Arch Ophthalmol. 2010;128(3):319-323. doi:10.1001/archophthalmol.2009.401.
Text Size: A A A
Published online

Objective  To determine the prevalence of hepatic abnormalities identified during abdominal computed tomography (CT) performed within 1 month of the diagnosis of primary uveal melanoma.

Methods  Retrospective review of CT reports generated within 1 month following diagnosis of uveal melanoma in 91 patients at Memorial Sloan-Kettering Cancer Center, New York, New York, from 2004 to 2009.

Results  Of 198 patients reviewed, 91 (46%) had a CT scan within 1 month of uveal melanoma diagnosis; 1 or more hepatic abnormalities were identified in 50 of these patients (55%). Abnormalities included 38 focal (13 solitary, 25 multiple) and 15 diffuse (11 partial, 4 complete) lesions. Six patients had hepatic lesions suspected to be metastatic melanoma, but this was confirmed in only 3. Lesions suspected to be metastases were more likely multiple than solitary (P = .03). Thirty-nine patients had other lesions, most commonly lesions that were too small to be characterized, a fatty liver, and hepatic cysts. Lesions in 5 of 50 patients with abnormalities could not be classified. Neither the protocol (triphasic vs nontriphasic) nor the center where the scan was performed (Sloan-Kettering vs other) was significantly related to the likelihood of identifying hepatic abnormalities in a given patient (P = .46 and P = .1, respectively).

Conclusion  Although hepatic abnormalities were frequently identified in patients who underwent CT within 1 month of uveal melanoma diagnosis, metastatic disease was confirmed only in the setting of multiple lesions in only a minority of patients.

Figures in this Article

It is recommended that patients with newly diagnosed primary uveal melanoma be evaluated for extraocular metastasis, as 20% to 25% of patients with primary uveal melanoma develop systemic disease within 5 years.1,2 In the Collaborative Ocular Melanoma Study, it was noted that less than 1% of patients with combined (large and medium) uveal melanoma tumors had abnormal liver function test results, and 2.5% had abnormal chest radiographic results.3 In addition, these tests have been found to have a high specificity but low sensitivity and are not an effective or reliable way to screen for metastasis.36 The sensitivity and specificity for patients in the Collaborative Ocular Melanoma Study who had abnormal liver function test results before diagnosis of metastasis were 14.7% and 92.3%, respectively.3 Chest radiography had a sensitivity and specificity of 1.8% and 100%, respectively.3

Uveal melanoma most often metastasizes hematogenously to the liver.1,3,4,713 The finding of distant metastases in patients with enucleated uveal melanoma who lack any local tumor recurrence suggests that micrometastases occur prior to diagnosis.14,15 Identification of a reliable liver screening test is warranted because the initial site of metastasis is the liver in 46% of patients,13 and 71.4% to 93% of patients eventually develop hepatic metastases during the course of their disease.2,10,11,13 In response to the Collaborative Ocular Melanoma Study findings that discounted the use of liver function tests and chest radiography as screening tools for metastases, we began screening our patients with preoperative computed tomographic (CT) scans.

Computed tomographic scans are often used to stage malignancy and monitor therapeutic progress.1628 The coincidental detection of nonmalignant hepatic abnormalities on CT scans is one obstacle that has been encountered in the use of CT as a screening tool for metastatic disease. For example, a nonmalignant lesion is found in 13% to 35% of patients with breast cancer, depending on the size of the lesion.2931 When we began routine screening, we noted that many of the CT scans had abnormalities.

Studies have suggested that the triphasic protocol may be more useful when screening for hepatic metastases.32,33 This protocol evaluates the liver in 3 different phases (unenhanced, hepatic arterial, and portal venous) to help identify a wide variety of abnormalities. The unenhanced images provide more consistent lesion measurement; hepatic arterial images help detect hypervascular lesions; and the portal venous images are better at identifying hypovascular malignancies.3234 For most CT scans, imaging collimations are usually between 5 and 8 mm, though this depends on the institution doing the study and the size of the liver.32,3436

The present study is a retrospective review of the initial CT findings in patients with recently diagnosed primary uveal melanoma at Memorial Sloan-Kettering Cancer Center. The purpose of the study is to help document the prevalence and type of hepatic abnormalities detected at the initial CT scan (not to assess the sensitivity, specificity, or accuracy of CT) to provide guidance for practicing physicians in terms of what results they can expect from an initial abdominal CT scan in a patient with uveal melanoma.

The medical records of 198 patients referred to Memorial Sloan-Kettering Cancer Center with uveal melanoma diagnoses from 2004 to 2009 were reviewed to identify those who underwent an abdominal CT scan (68 portal venous phase and 23 triphasic CT scans) within 1 month of diagnosis. Pregnant patients and those who had a CT scan more than 1 month after receiving their diagnosis were excluded. The electronic medical records were searched for the patient's age at diagnosis, sex, the time between diagnosis and initial CT scan, the center where the CT scan was performed (Memorial Sloan-Kettering Cancer Center vs other), and the type of CT protocol (triphasic vs nontriphasic).

Based on the original radiology reports, the CT scan results were classified into 1 of the following 4 groups: normal-appearing liver, hepatic abnormality detected (but not attributable to metastatic melanoma), questionable metastasis (unable to classify), and suspicious for metastatic disease. Subsequent imaging reports (if available) were also reviewed when initial CT scans could not be classified. If the scan was suspicious for metastatic disease, a biopsy was performed whenever possible, and the pathology and cytology reports were also reviewed. Of the 6 lesions suspected of being metastatic disease, only 4 had biopsies because one patient refused the procedure and another patient's lesion was evaluated with further imaging studies rather than biopsy for reasons unknown to the authors. Lesions were classified as either focal (solitary or multiple) or diffuse (partial or complete). A t test (df = 1) was performed to determine whether or not any statistically significant relationship existed between the finding of hepatic abnormalities on the CT scan and the type of CT protocol used or the particular center where the scan was administered. Owing to the small sample of patients with CT scans containing lesions suspected of being metastatic, a binomial proportion test was carried out to determine whether or not suspicious lesions were significantly more likely to be multiple or solitary. This retrospective analysis was performed with Memorial Sloan-Kettering Cancer Center institutional review board approval.

Of the 198 patients who received a diagnosis of uveal melanoma at our institution from 2004 to 2009, 91 (46%) underwent CT examination of the abdomen within 1 month. The 91 patients (49 men and 42 women) had a mean age of 60 years at initial diagnosis (median, 61 years; range, 18-84 years) and a mean latency from diagnosis of uveal melanoma to initial CT examination of 8 days (range, −8 to 31 days).

Forty-one (45%) of the patients' initial CT scans were classified as normal and 50 (55%) had an abnormality detected. The distribution for each of the groups and their respective subgroups are shown in Figure 1. Three of the 91 patients (3.3%) had confirmed hepatic metastasis. Of the abnormal CT scans, there were both focal (13 solitary and 25 multiple) and diffuse (11 partial and 4 complete) lesions. Neither the CT protocol (triphasic or nontriphasic) nor the location (Memorial Sloan-Kettering Cancer Center or other) of the CT scan showed a significant difference between normal and abnormal readings (P = .46 and P = .1, respectively). For reports classified as suspicious for metastasis, lesions were significantly more likely to be multiple than solitary (P = .03).

Place holder to copy figure label and caption
Figure 1.

Flow diagram shows results of retrospective review of computed tomography (CT) scan reports at Memorial Sloan-Kettering Cancer Center, New York, New York, from 2004 to 2009. TSTC indicates lesions too small to be characterized.

Graphic Jump Location

Previous studies have shown that the frequent finding of incidental, benign lesions confounds the use of abdominal CT as a screening tool for metastatic disease. In 1 study, benign hepatic tumors and other abnormalities were found in 52% of men between the ages of 35 and 69 years at autopsy, with the number of lesions increasing with age.37 Jones et al38 reported that 17% of patients had hepatic lesions that were 15 mm or smaller, and most of these patients had a concurrent extrahepatic malignant tumor. In 2 breast cancer studies, initial CT scan detected hepatic lesions 10 mm or smaller in 13% of patients29 and 15 mm or smaller in 35%.31 Another breast cancer study reported that hepatic lesions 15 mm or smaller were identified on initial CT in 30% of patients with no definite liver metastasis.30 Because these studies only documented small lesions, the percentage of patients with any type of hepatic abnormality is estimated to be even greater.

The current study reports that the prevalence of benign findings on abdominal CT similarly complicates screening for hepatic metastasis in patients with recent diagnoses of uveal melanoma. Computed tomography commonly detects a variety of benign hepatic abnormalities, including cysts, lesions that are too small to characterize, hemangiomas, and a fatty liver.2931,37,38 The current retrospective review identified lesions that were too small to be characterized, fatty livers, and hypoattenuating cysts as the 3 most common benign abnormalities found in the setting of uveal melanoma (Figure 2). Although hepatic abnormalities were identified in 55% of patients with uveal melanoma, only 3.3% were confirmed to be metastatic melanomas. It is important to acknowledge the possibility that the lesions classified at the initial CT as too small to characterize may have been metastatic melanomas that went undetected. Therefore, the 3.3% value may underestimate the incidence of metastatic disease in these patients. A future study reviewing follow-up CT reports for these patients would help clarify our findings.

Place holder to copy figure label and caption
Figure 2.

Examples of common abnormalities noted on computed tomographic scans following diagnosis of uveal melanoma. A, Hepatic cyst. B, Fatty liver. C, Lesion too small to be characterized (caret). D, Metastatic uveal melanoma.

Graphic Jump Location

Although triphasic CT is often preferred over standard CT for detecting and characterizing hepatic lesions,32 in the current study, the incidence and pattern of nonneoplastic lesions detected were not significantly related to the CT protocol used or the center where the scan was performed and reviewed. While our results suggest that neither the technique nor the location of the scan influenced the detection of hepatic abnormalities, only a rigorous, randomized prospective study could validate this observation.

Studies have shown that the likelihood of detecting a malignancy on an abdominal CT scan increases with the number of lesions identified.38 The results of the current study provide further support for this finding. Patients with multiple lesions, rather than 1, were significantly more likely to have lesions suspected of being metastatic melanoma (P = .03).Although the identification of multiple lesions on a CT scan does not, in and of itself, indicate a diagnosis of metastatic disease, the finding is significant in that it increases the likelihood that a particular patient has a metastatic lesion and it should raise a physician's clinical index of suspicion. These results may help physicians who wish to provide guidance to their patients in terms of what results to expect from a CT scan following a diagnosis of uveal melanoma.

Correspondence: David H. Abramson, MD, Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, 70 E 66th St, New York, NY 10065 (abramsod@mskcc.org).

Submitted for Publication: August 13, 2009; final revision received November 17, 2009; accepted November 19, 2009.

Financial Disclosure: None reported.

Funding/Support: This study was partly supported by The Fund for Ophthalmic Knowledge Inc.

Diener-West  MReynolds  SMAgugliaro  DJ  et al. Collaborative Ocular Melanoma Study Group, Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26. Arch Ophthalmol 2005;123 (12) 1639- 1643
PubMed Link to Article
Gragoudas  ESSeddon  JMEgan  KM  et al.  Metastasis from uveal melanoma after proton beam irradiation. Ophthalmology 1988;95 (7) 992- 999
PubMed Link to Article
Diener-West  MReynolds  SMAgugliaro  DJ  et al. Collaborative Ocular Melanoma Study Group Report 23, Screening for metastasis from choroidal melanoma: the Collaborative Ocular Melanoma Study Group Report 23. J Clin Oncol 2004;22 (12) 2438- 2444
PubMed Link to Article
Finger  PTKurli  MReddy  STena  LBPavlick  AC Whole body PET/CT for initial staging of choroidal melanoma. Br J Ophthalmol 2005;89 (10) 1270- 1274
PubMed Link to Article
Hicks  CFoss  AJHungerford  JL Predictive power of screening tests for metastasis in uveal melanoma. Eye (Lond) 1998;12 (pt 6) 945- 948
PubMed Link to Article
Missotten  GSKeunen  JE Screening for uveal melanoma metastasis: literature review. Bull Soc Belge Ophtalmol 2004;294 (294) 13- 22
PubMed
Shields  CLShields  JA Ocular melanoma: relatively rare but requiring respect. Clin Dermatol 2009;27 (1) 122- 133
PubMed Link to Article
Donoso  LABerd  DAugsburger  JJMastrangelo  MJShields  JA Metastatic uveal melanoma: pretherapy serum liver enzyme and liver scan abnormalities. Arch Ophthalmol 1985;103 (6) 796- 798
PubMed Link to Article
Rietschel  PPanageas  KSHanlon  CPatel  AAbramson  DHChapman  PB Variates of survival in metastatic uveal melanoma. J Clin Oncol 2005;23 (31) 8076- 8080
PubMed Link to Article
Kath  RHayungs  JBornfeld  NSauerwein  WHöffken  KSeeber  S Prognosis and treatment of disseminated uveal melanoma. Cancer 1993;72 (7) 2219- 2223
PubMed Link to Article
Lorigan  JGWallace  SMavligit  GM The prevalence and location of metastases from ocular melanoma: imaging study in 110 patients. AJR Am J Roentgenol 1991;157 (6) 1279- 1281
PubMed Link to Article
Collaborative Ocular Melanoma Study Group, Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report No. 15. Arch Ophthalmol 2001;119 (5) 670- 676
PubMed Link to Article
Rajpal  SMoore  RKarakousis  CP Survival in metastatic ocular melanoma. Cancer 1983;52 (2) 334- 336
PubMed Link to Article
Gragoudas  ESMarie Lane  A Uveal melanoma: proton beam irradiation. Ophthalmol Clin North Am 2005;18 (1) 111- 118, ix
PubMed Link to Article
Char  DHPhillips  TDaftari  I Proton teletherapy of uveal melanoma. Int Ophthalmol Clin 2006;46 (1) 41- 49
PubMed Link to Article
Eberhardt  SCChoi  PHBach  AMFunt  SAFelderman  HEHann  LE Utility of sonography for small hepatic lesions found on computed tomography in patients with cancer. J Ultrasound Med 2003;22 (4) 335- 346
PubMed
Scaife  CLNg  CSEllis  LMVauthey  JNCharnsangavej  CCurley  SA Accuracy of preoperative imaging of hepatic tumors with helical computed tomography. Ann Surg Oncol 2006;13 (4) 542- 546
PubMed Link to Article
Aoyama  TMastrangelo  MJBerd  D  et al.  Protracted survival after resection of metastatic uveal melanoma. Cancer 2000;89 (7) 1561- 1568
PubMed Link to Article
Becker  JCTerheyden  PKämpgen  E  et al.  Treatment of disseminated ocular melanoma with sequential fotemustine, interferon alpha, and interleukin 2. Br J Cancer 2002;87 (8) 840- 845
PubMed Link to Article
Schmittel  AScheulen  MEBechrakis  NE  et al.  Phase II trial of cisplatin, gemcitabine and treosulfan in patients with metastatic uveal melanoma. Melanoma Res 2005;15 (3) 205- 207
PubMed Link to Article
Carrasco  CHWallace  SCharnsangavej  CPapadopoulos  NEPatt  YZMavligit  GM Treatment of hepatic metastases in ocular melanoma: embolization of the hepatic artery with polyvinyl sponge and cisplatin. JAMA 1986;255 (22) 3152- 3154
PubMed Link to Article
Duh  EJSchachat  APAlbert  DMPatel  SM Long-term survival in a patient with uveal melanoma and liver metastasis. Arch Ophthalmol 2004;122 (2) 285- 287
PubMed Link to Article
O'Neill  PAButt  MEswar  CVGillis  PMarshall  E A prospective single arm phase II study of dacarbazine and treosulfan as first-line therapy in metastatic uveal melanoma. Melanoma Res 2006;16 (3) 245- 248
PubMed Link to Article
Peters  SVoelter  VZografos  L  et al.  Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients. Ann Oncol 2006;17 (4) 578- 583
PubMed Link to Article
Pyrhönen  SHahka-Kemppinen  MMuhonen  T A promising interferon plus four-drug chemotherapy regimen for metastatic melanoma. J Clin Oncol 1992;10 (12) 1919- 1926
PubMed
Salmon  RJLevy  CPlancher  C  et al.  Treatment of liver metastases from uveal melanoma by combined surgery-chemotherapy. Eur J Surg Oncol 1998;24 (2) 127- 130
PubMed Link to Article
Siegel  RHauschild  AKettelhack  CKähler  KCBembenek  ASchlag  PM Hepatic arterial Fotemustine chemotherapy in patients with liver metastases from cutaneous melanoma is as effective as in ocular melanoma. Eur J Surg Oncol 2007;33 (5) 627- 632
PubMed Link to Article
Soni  SLee  DSDiVito  J  Jr  et al.  Treatment of pediatric ocular melanoma with high-dose interleukin-2 and thalidomide. J Pediatr Hematol Oncol 2002;24 (6) 488- 491
PubMed Link to Article
Schwartz  LHGandras  EJColangelo  SMErcolani  MCPanicek  DM Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology 1999;210 (1) 71- 74
PubMed Link to Article
Khalil  HIPatterson  SAPanicek  DM Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology 2005;235 (3) 872- 878
PubMed Link to Article
Krakora  GACoakley  FVWilliams  GYeh  BMBreiman  RSQayyum  A Small hypoattenuating hepatic lesions at contrast-enhanced CT: prognostic importance in patients with breast cancer. Radiology 2004;233 (3) 667- 673
PubMed Link to Article
Miller  FHButler  RSHoff  FLFitzgerald  SWNemcek  AA  JrGore  RM Using triphasic helical CT to detect focal hepatic lesions in patients with neoplasms. AJR Am J Roentgenol 1998;171 (3) 643- 649
PubMed Link to Article
Oliver  JH  IIIBaron  RLFederle  MPJones  BCSheng  R Hypervascular liver metastases: do unenhanced and hepatic arterial phase CT images affect tumor detection? Radiology 1997;205 (3) 709- 715
PubMed
Zeman  RKBaron  RLJeffrey  RB  JrKlein  JSiegel  MJSilverman  PM Helical body CT: evolution of scanning protocols. AJR Am J Roentgenol 1998;170 (6) 1427- 1438
PubMed Link to Article
Kemmerer  SRMortele  KJRos  PR CT scan of the liver. Radiol Clin North Am 1998;36 (2) 247- 261
PubMed Link to Article
Hopper  KDSingapuri  KFinkel  A Body CT and oncologic imaging. Radiology 2000;215 (1) 27- 40
PubMed Link to Article
Karhunen  PJ Benign hepatic tumours and tumour like conditions in men. J Clin Pathol 1986;39 (2) 183- 188
PubMed Link to Article
Jones  ECChezmar  JLNelson  RCBernardino  ME The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 1992;158 (3) 535- 539
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Flow diagram shows results of retrospective review of computed tomography (CT) scan reports at Memorial Sloan-Kettering Cancer Center, New York, New York, from 2004 to 2009. TSTC indicates lesions too small to be characterized.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Examples of common abnormalities noted on computed tomographic scans following diagnosis of uveal melanoma. A, Hepatic cyst. B, Fatty liver. C, Lesion too small to be characterized (caret). D, Metastatic uveal melanoma.

Graphic Jump Location

Tables

References

Diener-West  MReynolds  SMAgugliaro  DJ  et al. Collaborative Ocular Melanoma Study Group, Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26. Arch Ophthalmol 2005;123 (12) 1639- 1643
PubMed Link to Article
Gragoudas  ESSeddon  JMEgan  KM  et al.  Metastasis from uveal melanoma after proton beam irradiation. Ophthalmology 1988;95 (7) 992- 999
PubMed Link to Article
Diener-West  MReynolds  SMAgugliaro  DJ  et al. Collaborative Ocular Melanoma Study Group Report 23, Screening for metastasis from choroidal melanoma: the Collaborative Ocular Melanoma Study Group Report 23. J Clin Oncol 2004;22 (12) 2438- 2444
PubMed Link to Article
Finger  PTKurli  MReddy  STena  LBPavlick  AC Whole body PET/CT for initial staging of choroidal melanoma. Br J Ophthalmol 2005;89 (10) 1270- 1274
PubMed Link to Article
Hicks  CFoss  AJHungerford  JL Predictive power of screening tests for metastasis in uveal melanoma. Eye (Lond) 1998;12 (pt 6) 945- 948
PubMed Link to Article
Missotten  GSKeunen  JE Screening for uveal melanoma metastasis: literature review. Bull Soc Belge Ophtalmol 2004;294 (294) 13- 22
PubMed
Shields  CLShields  JA Ocular melanoma: relatively rare but requiring respect. Clin Dermatol 2009;27 (1) 122- 133
PubMed Link to Article
Donoso  LABerd  DAugsburger  JJMastrangelo  MJShields  JA Metastatic uveal melanoma: pretherapy serum liver enzyme and liver scan abnormalities. Arch Ophthalmol 1985;103 (6) 796- 798
PubMed Link to Article
Rietschel  PPanageas  KSHanlon  CPatel  AAbramson  DHChapman  PB Variates of survival in metastatic uveal melanoma. J Clin Oncol 2005;23 (31) 8076- 8080
PubMed Link to Article
Kath  RHayungs  JBornfeld  NSauerwein  WHöffken  KSeeber  S Prognosis and treatment of disseminated uveal melanoma. Cancer 1993;72 (7) 2219- 2223
PubMed Link to Article
Lorigan  JGWallace  SMavligit  GM The prevalence and location of metastases from ocular melanoma: imaging study in 110 patients. AJR Am J Roentgenol 1991;157 (6) 1279- 1281
PubMed Link to Article
Collaborative Ocular Melanoma Study Group, Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report No. 15. Arch Ophthalmol 2001;119 (5) 670- 676
PubMed Link to Article
Rajpal  SMoore  RKarakousis  CP Survival in metastatic ocular melanoma. Cancer 1983;52 (2) 334- 336
PubMed Link to Article
Gragoudas  ESMarie Lane  A Uveal melanoma: proton beam irradiation. Ophthalmol Clin North Am 2005;18 (1) 111- 118, ix
PubMed Link to Article
Char  DHPhillips  TDaftari  I Proton teletherapy of uveal melanoma. Int Ophthalmol Clin 2006;46 (1) 41- 49
PubMed Link to Article
Eberhardt  SCChoi  PHBach  AMFunt  SAFelderman  HEHann  LE Utility of sonography for small hepatic lesions found on computed tomography in patients with cancer. J Ultrasound Med 2003;22 (4) 335- 346
PubMed
Scaife  CLNg  CSEllis  LMVauthey  JNCharnsangavej  CCurley  SA Accuracy of preoperative imaging of hepatic tumors with helical computed tomography. Ann Surg Oncol 2006;13 (4) 542- 546
PubMed Link to Article
Aoyama  TMastrangelo  MJBerd  D  et al.  Protracted survival after resection of metastatic uveal melanoma. Cancer 2000;89 (7) 1561- 1568
PubMed Link to Article
Becker  JCTerheyden  PKämpgen  E  et al.  Treatment of disseminated ocular melanoma with sequential fotemustine, interferon alpha, and interleukin 2. Br J Cancer 2002;87 (8) 840- 845
PubMed Link to Article
Schmittel  AScheulen  MEBechrakis  NE  et al.  Phase II trial of cisplatin, gemcitabine and treosulfan in patients with metastatic uveal melanoma. Melanoma Res 2005;15 (3) 205- 207
PubMed Link to Article
Carrasco  CHWallace  SCharnsangavej  CPapadopoulos  NEPatt  YZMavligit  GM Treatment of hepatic metastases in ocular melanoma: embolization of the hepatic artery with polyvinyl sponge and cisplatin. JAMA 1986;255 (22) 3152- 3154
PubMed Link to Article
Duh  EJSchachat  APAlbert  DMPatel  SM Long-term survival in a patient with uveal melanoma and liver metastasis. Arch Ophthalmol 2004;122 (2) 285- 287
PubMed Link to Article
O'Neill  PAButt  MEswar  CVGillis  PMarshall  E A prospective single arm phase II study of dacarbazine and treosulfan as first-line therapy in metastatic uveal melanoma. Melanoma Res 2006;16 (3) 245- 248
PubMed Link to Article
Peters  SVoelter  VZografos  L  et al.  Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients. Ann Oncol 2006;17 (4) 578- 583
PubMed Link to Article
Pyrhönen  SHahka-Kemppinen  MMuhonen  T A promising interferon plus four-drug chemotherapy regimen for metastatic melanoma. J Clin Oncol 1992;10 (12) 1919- 1926
PubMed
Salmon  RJLevy  CPlancher  C  et al.  Treatment of liver metastases from uveal melanoma by combined surgery-chemotherapy. Eur J Surg Oncol 1998;24 (2) 127- 130
PubMed Link to Article
Siegel  RHauschild  AKettelhack  CKähler  KCBembenek  ASchlag  PM Hepatic arterial Fotemustine chemotherapy in patients with liver metastases from cutaneous melanoma is as effective as in ocular melanoma. Eur J Surg Oncol 2007;33 (5) 627- 632
PubMed Link to Article
Soni  SLee  DSDiVito  J  Jr  et al.  Treatment of pediatric ocular melanoma with high-dose interleukin-2 and thalidomide. J Pediatr Hematol Oncol 2002;24 (6) 488- 491
PubMed Link to Article
Schwartz  LHGandras  EJColangelo  SMErcolani  MCPanicek  DM Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology 1999;210 (1) 71- 74
PubMed Link to Article
Khalil  HIPatterson  SAPanicek  DM Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology 2005;235 (3) 872- 878
PubMed Link to Article
Krakora  GACoakley  FVWilliams  GYeh  BMBreiman  RSQayyum  A Small hypoattenuating hepatic lesions at contrast-enhanced CT: prognostic importance in patients with breast cancer. Radiology 2004;233 (3) 667- 673
PubMed Link to Article
Miller  FHButler  RSHoff  FLFitzgerald  SWNemcek  AA  JrGore  RM Using triphasic helical CT to detect focal hepatic lesions in patients with neoplasms. AJR Am J Roentgenol 1998;171 (3) 643- 649
PubMed Link to Article
Oliver  JH  IIIBaron  RLFederle  MPJones  BCSheng  R Hypervascular liver metastases: do unenhanced and hepatic arterial phase CT images affect tumor detection? Radiology 1997;205 (3) 709- 715
PubMed
Zeman  RKBaron  RLJeffrey  RB  JrKlein  JSiegel  MJSilverman  PM Helical body CT: evolution of scanning protocols. AJR Am J Roentgenol 1998;170 (6) 1427- 1438
PubMed Link to Article
Kemmerer  SRMortele  KJRos  PR CT scan of the liver. Radiol Clin North Am 1998;36 (2) 247- 261
PubMed Link to Article
Hopper  KDSingapuri  KFinkel  A Body CT and oncologic imaging. Radiology 2000;215 (1) 27- 40
PubMed Link to Article
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PubMed Link to Article

Correspondence

CME


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