What is the most accurate whole-body imaging modality for assessment of local and distant recurrent disease in colorectal cancer? A meta-analysis

Abstract

PurposeThe objective of this study was to compare the diagnostic performance of positron emission tomography (PET), PET/CT, CT and MRI as whole-body imaging modalities for the detection of local and/or distant recurrent disease in colorectal cancer (CRC) patients who have a (high) suspicion of recurrent disease, based on clinical findings or rise in carcinoembryonic antigen (CEA).MethodsA meta-analysis was undertaken. PubMed and Embase were searched for studies on the accuracy of whole-body imaging for patients with suspected local and/or distant recurrence of their CRC. Additionally, studies had to have included at least 20 patients with CRC and 2 × 2 contingency tables had to be provided or derivable. Articles evaluating only local recurrence or liver metastasis were excluded. Summary receiver-operating characteristic (ROC) curves were constructed from the data on sensitivity and specificity of individual studies and pooled estimates of diagnostic odds ratios (DORs) and areas under the ROC curve (AUCs) were calculated. To test for heterogeneity the Cochran Q test was used.ResultsFourteen observational studies were included which evaluated PET, PET/CT, CT and/or MRI. Study results were available in 12 studies for PET, in 5 studies for CT, in 5 studies for PET/CT and in 1 study for MRI. AUCs for PET, PET/CT and CT were 0.94 (0.90–0.97), 0.94 (0.87–0.98) and 0.83 (0.72–0.90), respectively. In patient based analyses PET/CT had a higher diagnostic performance than PET with an AUC of 0.95 (0.89–0.97) for PET/CT vs 0.92 (0.86–0.96) for PET.ConclusionBoth whole-body PET and PET/CT are very accurate for the detection of local and/or distant recurrent disease in CRC patients with a (high) suspicion of recurrent disease. CT has the lowest diagnostic performance. This difference is probably mainly due to the lower accuracy of CT for detection of extrahepatic metastases (including local recurrence). For clinical practice PET/CT might be the modality of choice when evaluating patients with a (high) suspicion of recurrent disease, because of its best performance in patient based analyses and confident prediction of disease status.

Surgical resection of hepatic metastasis from gastric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines

“…Among 319 patients with relevant information in the current series, 195 (61.1 %) actually had solitary metastases. One should note, however, that the number of nodules can differ, depending on the type of imaging studies used [24,25]. Because most institutions needed more than a decade to accumulate 15 patients or more, there should have been much difference in the potential of imaging modalities at the beginning and the end of the study period.…”

18F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

“…In the follow-up of colorectal cancers, 18 F-FDG PET/CT has been shown to have good diagnostic accuracy, has an impact in patient management, and predicts prognosis (3)(4)(5)(6)(7)(8). Although 18 F-FDG PET/CT has not been recommended in the routine follow-up of colorectal cancer, studies have shown that PET/CT is superior to conventional imaging methods in the follow-up (9)(10)(11).…”

Serum tumor markers and PET/CT imaging for tumor recurrence detection

“…When using PET/CT machines, lesion characterization in the CT portion of a PET/CT study increases the specificity of PET/ CT reporting, especially for lesions with moderate and marked FDG uptake. Accordingly, using combined FDG PET/CT imaging for the purpose of tumor recurrence detection in CRC patients with rising CEA levels, specificity proved significantly better when compared to standalone FDG PET imaging with reported figures varying from 92 to 96 % as evidenced by a more recent metaanalysis [49]. Overall, PET/CT allows detection of tumor recurrence in CRC patients with rising CEA levels with an overall sensitivity and specificity of 95 %.…”

“…For this purpose, CT has both a low sensitivity and specificity [49]. While MRI performs better in differentiating local recurrence from scar tissue when compared to CT, limitations still exist in terms of specificity and in the size of tumor detectability [50].…”