Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer

Abstract

Background: The role of positron emission tomography with the glucose analogue [18F] fluoro-2-deoxy-D-glucose (FDG-PET) in the initial staging of disease in patients with primary colorectal cancer (CRC) has not been adequately assessed. Aims: To evaluate the additional value of FDG-PET as a staging modality, complementary to routine multidetector row computed tomography (MDCT) in patients with CRC. Methods: Forty four patients with CRC underwent preoperative MDCT and FDG-PET. The accuracy of intraoperative macroscopic staging was also investigated compared with histopathological diagnosis. All FDG-PET images were evaluated with respect to detectability of the primary tumour, lymph node involvement, and distant metastases. Both MDCT and FDG-PET diagnoses and treatment plan were compared with surgical and histopathological results. Results: Thirty seven patients underwent surgery. Tumour detection rate was 95% (42/44) for MDCT, 100% (44/44) for FDG-PET, and 100% (37/37) for intraoperative macroscopic diagnosis. Pathological diagnosis of T factor was T1 in five, T2 in four, T3 in 24, and T4 in four cases. Concordance rate with pathological findings of T factor was 57% (21/37) for MDCT and 62% (23/37) for macroscopic diagnosis. Lymph node involvement was pathologically positive in 19 cases. Regarding N factor, overall accuracy was 62% (23/37) for MDCT, 59% (22/37) for FDG-PET, and 70% (26/37) for macroscopic diagnosis. For all 44 patients, FDG-PET findings resulted in treatment changes in only one (2%) patient. Conclusion: FDG-PET is not superior to routine MDCT in the initial staging of primary CRC.

IS There A Role of 18F-FDG PET/CT for Initial Staging of Rectal Cancer ?

“…They reported alteration in tumor and nodal stage of 31% and 46%, respectively, while change in patients' management occurred in 14% of patients. Similar results were obtained by others who performed PET alone or PET/CT imaging on much smaller number of patients [22,[38][39][40].…”

“…The main disadvantage of CT is low spatial and contrast resolution, however its role is mostly in the detection of distant metastases. CT technology has significantly advanced with the development of multidetector row CT (MDTC), which allows high-resolution imaging and reduces acquisition time [22]. Despite improved resolution, however, CT has limitations in the N staging of CRC patients [23].…”

S3-Leitlinie – Kolorektales Karzinom

“…Unklar ist die Qualität der Vergleichsmethoden. In neueren Studien mit Multidetector-Spiral-CT erscheint kein wesentlicher Unterschied nachweisbar [657,658].…”

Usefulness of Positron Emission Tomography in the Evaluation of Distribution and Activity of Systemic Lesions Associated with Autoimmune Pancreatitis

“…Positron emission tomography (PET) using the glucose analog 18 F-fluorodeoxyglucoase (FDG-PET) is a non-invasive imaging technique that is studied for its effects on the diagnosis and staging of various malignancies [1,2] . However, FDG accumulation is also recognized in physiological [3,4] and inflammatory conditions [2,5,6] .…”