Routine use of positron-emission tomography/computed tomography for staging of primary colorectal cancer: Does it affect clinical management?

Abstract

BackgroundThe use of positron emission tomography-computed tomography (PET/CT) for the preoperative staging of patients with colon and rectal cancer has increased steadily over the last decade. The aim of this study was to evaluate the effect of PET/CT on the preoperative staging and clinical management of patients with colorectal cancer.MethodsBetween December 2010 and February 2012, 64 consecutive patients with colorectal cancer were evaluated with both PET/CT scans and conventional preoperative imaging studies. We prospectively recorded the medical reports of these patients. The PET/CT findings were compared with conventional imaging studies and the rate of over-staging or down-staging and changes in clinical management were evaluated. The correlation of the PET/CT with the conventional imaging was compared by a kappa agreement coefficient. Differences in the accuracy for N and T staging were assessed by χ2 and related-samples marginal homogeneity tests.ResultsThirty-nine (60.9%) patients had rectal cancer and 25 (39.1%) had colon cancer. Based on PET/CT, additional lesions were found in 6 (9.4%) of the patients: hilar and paratracheal lesions in 4 patients, hepatic in 1 and supraclavicular in 1 patient. In four of six patients, detailed imaging studies or biopsies revealed chronic inflammatory changes. Hepatic and supraclavicular involvement was confirmed in two patients. Therefore, the false positivity rate of PET/CT was 6.25%. Based on the additional PET/CT, 2 (3.2%) patients had a change in surgical management. A chemotherapy regimen was administered to the patient with a 1.5 cm hepatic metastasis near the right hepatic vein; for another patient with an identified supraclavicular lymph node metastasis, a simultaneous excision was performed.ConclusionsRoutine use of PET/CT for preoperative staging did not impact disease management for 96.8% of our patients. The results of our study conclude that PET/CT should not be routinely used for primary staging of colorectal cancer. More studies are required for identifying the subgroup of patients who might benefit from a PET/CT in their initial staging.

Assessment and diagnostic accuracy of lymph node status to predict stage III colon cancer using computed tomography

“…Some authors argues that routine use of PET/CT can alter or change the management in stage III patients (6.5%) and stage IV patients (12.7%) while other authors claim that it does not [27, 28]. …”

Diagnostic and prognostic value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography for colorectal cancer: comparison with conventional computed tomography

“…CT is an established method for staging CRC, and a cross-sectional imaging technique that uses X-rays provides detailed anatomical information 8. FDG-PET/CT scan is not routinely indicated and should be used to evaluate an equivocal finding on a contrast-enhanced CT scan or in patients with contraindications to intravenous contrast 9. However, according to several studies, FDG-PET/CT can be a valuable tool in accurate staging; FDG-PET/CT can aid in the management of patients with primary CRC, and can be useful for ambiguous or equivocal lesions on CT 101112.…”

Colon cancer: assessment and monitoring

“…Cependant, son utilisation systématique n'apporte pas de bénéfice et n'impacte pas sur la prise en charge dans 96 % des cas [33]. Sa place doit être réservée aux patients ayant des métastases hépatiques chez qui une intervention chirurgicale est envisagée.…”