Whole-Body PET Imaging With [18F]Fluorodeoxyglucose in Management of Recurrent Colorectal Cancer

Abstract

Hypothesis: Metabolic imaging by positron emission tomography (PET) using [ 18 F]fluorodeoxyglucose will be more accurate than anatomic imaging by computed tomography (CT) for detection of recurrent colorectal cancer. More accurate staging of recurrent tumor by PET will lead to more appropriate management decisions. Design: Prospective blinded study comparing PET with CT, using histologic diagnosis, serial CT imaging, and clinical follow-up as criterion standards, with a fully blinded, retrospective reinterpretation of PET studies. Changes in diagnosis resulting from PET findings were correlated with subsequent treatment and surgical findings. Potential cost savings resulting from use of PET for preoperative staging were calculated. Setting: Private practice in an outpatient tertiary referral center. Patients: A group of 155 consecutive patients with imaging for diagnosis or staging of recurrent colorectal cancer. Twenty-one patient (14%) were excluded due to lack of a criterion standard. Computed tomographic scans were available for comparison for 115 patients. Results: Positron emission tomographic scan sensitivity and specificity were 93% and 98%, respectively, compared with 69% and 96% for CT. Ninety-five percent confidence intervals for the differences between the modalities were 16% to 32% for sensitivity and 1% to 5% for specificity. The sensitivity of both modalities varied with anatomic site of recurrence. Positron emission tomographic scans were true positive in 12 (67%) of 18 patients with elevated serum carcinoembryonic antigen levels and negative CT findings. In 23 (29%) of 78 preoperative studies in which CT showed a single site of recurrence, PET showed tumor at additional sites. At surgery, nonresectable, PET-negative tumor was found in 7 (17%) of 42 patients who had PET evidence of localized recurrence only. Potential savings resulting from demonstration of nonresectable tumor by PET were calculated at $3003 per preoperative study. Conclusions: Positron emission tomography was more sensitive and specific than CT for detection of recurrent colorectal cancer. Preoperative detection of nonresectable tumor by PET may avoid unnecessary surgery, and thereby reduce the cost of patient treatment.

Value of Surveillance 18F-FDG PET/CT in Colorectal Cancer: Comparison with Conventional Imaging Studies

“…Of four metachronous tumors, two (thyroid cancer and bronchioalveolar carcinoma) were revealed only by PET/CT. [7,[14][15][16]. However, in most of these, the objective was to assess the ability of PET or PET/CT to visualize a recurrence that was clinically already highly suspected.…”

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

“…Previous series have included between 23 [12] and 107 [18] patients with 5 [12] to 40 [14] PC, but not all PC were of colorectal origin, possibly associated with various FDG uptake. The PET/CT method for CRC has been evaluated in larger series [19][20][21][22][23][24][25] but without a focus on PC. The prevalence of PC in our centre which is a regional reference centre for relapse cancer was 24% (35/146 patients).…”

Impacto clínico de la PET con 18FDG en la selección de la terapia de los pacientes oncológicos

“…Este cambio de actitud terapéutica se explica por una una mayor sensibilidad de la PET con respecto a la TAC en la valoración de la infiltración tumoral del abdomen, la pelvis y el retroperitoneo, así como por su capacidad de detectar enfermedad tumoral en localizaciones pocos habituales (mediastino, hueso y glándulas suprarrenales) 24 . En nuestro estudio detectamos lesiones metastásicas en localizaciones poco frecuentes como el páncreas y la columna vertebral.…”