The influence of 18F-fluorodeoxyglucose positron emission tomography/computed tomography on the N- and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is a highly metastatic cancer. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) enables sensitive tumor and metastasis detection. Our aim is to evaluate the influence of pre-treatment PET/CT on the N-and M-staging and subsequent clinical management in ICC patients.Methods: Between August 2010 and August 2018, 660 consecutive ICC patients, without prior anti-tumor treatments nor other malignancies, were enrolled. The diagnostic performance of PET/CT on the N-and M-staging was compared with conventional imaging, and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated. Survival difference was compared between patients receiving PET/CT or not after propensity score matching.Results: Patients were divided into group A (n=291) and group B (n=369) according to whether PET/CT was performed. Among 291 patients with both PET/CT and conventional imaging for staging in group A, PET/CT showed significantly higher sensitivity (83.0% vs. 70.5%, P=0.001), specificity (88.3% vs. 74.9%, P<0.001) and accuracy (86.3% vs. 73.2%, P<0.001) than conventional imaging in diagnosing regional lymph node metastasis, as well as higher sensitivity (87.8% vs. 67.6%, P<0.001) and accuracy (93.5% vs. 89.3%, P=0.023) in diagnosing distant metastasis. Overall, PET/CT improved the accuracy of preoperative staging from 60.1% to 71.8% (P<0.001), and modified clinical treatment strategy in 5.8% (17/291) of ICC patients, with unique roles in different TNM stages. High tumor-to-non-tumor ratio (TNR) predicted poor overall survival [hazard ratio (HR) 2.17, 95% confidence interval (CI): 1.49-3.15, P<0.001]. Furthermore, patients performing PET/CT had longer overall survival compared with those without PET/CT (HR 0.74, 95% CI: 0.58-0.93, P=0.011) after propensity score matching.Conclusions: PET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients, and facilitated accurate tumor staging and optimal treatment allocation.

18F-fluorodeoxyglucose positron emission tomography for intrahepatic cholangiocarcinoma N- and M-staging: should guidelines recommend it at last?

“…tomography on the N-and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma" in HepatoBiliary Surgery and Nutrition (1). A 291-patient population affected by intrahepatic cholangiocarcinoma (ICC) was retrospectively analyzed with the aim of assessing the accuracy of preoperative staging and treatment reallocation by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/ CT) (1).…”

“…tomography on the N-and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma" in HepatoBiliary Surgery and Nutrition (1). A 291-patient population affected by intrahepatic cholangiocarcinoma (ICC) was retrospectively analyzed with the aim of assessing the accuracy of preoperative staging and treatment reallocation by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/ CT) (1). Through a comparison of conventional imaging examinations [computed tomography (CT) and/or magnetic resonance imaging (MRI)] with 18 F-FDG PET/CT, the latter recorded a higher diagnostic accuracy as concerned both lymph node (LNM) and distant metastases (DM) (1).…”

“…A 291-patient population affected by intrahepatic cholangiocarcinoma (ICC) was retrospectively analyzed with the aim of assessing the accuracy of preoperative staging and treatment reallocation by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/ CT) (1). Through a comparison of conventional imaging examinations [computed tomography (CT) and/or magnetic resonance imaging (MRI)] with 18 F-FDG PET/CT, the latter recorded a higher diagnostic accuracy as concerned both lymph node (LNM) and distant metastases (DM) (1). In particular, authors highlighted more significant results in terms of sensitivity (LNM: 83% vs. 70.5%; DM: 87.8% vs. 67.6%) and diagnostic accuracy (LNM: 86.3% vs. 73.2%; DM: 93.5% vs. 89.3%) for both types of metastases, in addition to more outstanding specificity (88.3% vs. 74.9%) just in LNM (1).…”

“…Through a comparison of conventional imaging examinations [computed tomography (CT) and/or magnetic resonance imaging (MRI)] with 18 F-FDG PET/CT, the latter recorded a higher diagnostic accuracy as concerned both lymph node (LNM) and distant metastases (DM) (1). In particular, authors highlighted more significant results in terms of sensitivity (LNM: 83% vs. 70.5%; DM: 87.8% vs. 67.6%) and diagnostic accuracy (LNM: 86.3% vs. 73.2%; DM: 93.5% vs. 89.3%) for both types of metastases, in addition to more outstanding specificity (88.3% vs. 74.9%) just in LNM (1). Overall, through inclusion of 18 F-FDG PET/CT, the rate of diagnostic accuracy in preoperative staging increased from 60.1% to 71.8% (1).…”

“…Overall, through inclusion of 18 F-FDG PET/CT, the rate of diagnostic accuracy in preoperative staging increased from 60.1% to 71.8% (1). Furthermore, treatment strategies for 5.8% cases changed to the point of avoiding unnecessary surgery (1). Therefore, authors came to the conclusion that the use of 18 F-FDG PET/CT should be recommended in preoperative staging, due to the high rate of metastases for ICC (1).…”