Asian Pacific Journal of Cancer Prevention

  • 제17권8호
  • /
  • Pages.4071-4075
  • /
  • 2016
  • /
  • 1513-7368(pISSN)
  • /
  • 2476-762X(eISSN)
아시아태평양암예방학회 (Asian Pacific Journal of Cancer Prevention)
권호 표지
DOI QR코드

DOI QR Code

Value of FDG PET/Contrast-Enhanced CT in Initial Staging of Colorectal Cancer - Comparison with Contrast-Enhanced CT

  • 발행 : 2016.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background: FDG PET/CT is at an equivocal stage to recommend for staging of colorectal cancer as compared to contrast-enhanced CT (ceCT). This study was intended to evaluate the value of FDG PET/ceCT in colorectal cancer staging as compared to ceCT alone. Materials and Methods: PET/ceCT was performed for 61 colorectal cancer patients who were prospectively enrolled in the study. Three patients were excluded due to loss to follow-up. PET/ceCT findings and ceCT results alone were read separately. The treatment planning was then determined by tumor board consensus. The criteria for T staging were determined by the findings of ceCT. Nodal positive by PET/ceCT imaging was determined by visual analysis of FDG uptake greater than regional background blood pool activity. The diagnostic accuracy of T and N staging was determined only in patients who received surgery without any neoadjuvant treatment. Results: Of 58 patients, there were 40 with colon cancers including sigmoid cancers and 18 with rectal cancers. PET/ceCT in pre-operative staging detected bone metastasis and metastatic inguinal lymph nodes (M1a) that were undepicted on CT in 2 patients (3%), clearly defined 19 equivocal lesions on ceCT in 18 patients (31%) and excluded 6 metastatic lesions diagnosed by ceCT in 6 patients (10%). These resulted in alteration of management plan in 15 out of the 58 cases (26%) i.e. changing from chemotherapy to surgery (4), changing extent of surgery (9) and avoidance of futile surgery (2). Forty four patients underwent surgery within 45 days after PET/CT. The diagnostic accuracy for N staging with PET/ceCT and ceCT alone was 66% and 48% with false positive rates of 24% (6/25) and 76% (19/25) and false negative rates of 47% (9/19) and 21% (4/19), respectively. All of the false negative lymph nodes from PET/ceCT were less than a centimeter in size and located in peri-lesional regions. The diagnostic accuracy for T staging was 82%. The sensitivity of the peri-lesional fat stranding sign in determining T3 stage was 94% and the specificity was 54%. Conclusions: Our study suggested promising roles of PET/ceCT in initial staging of colorectal cancer with better diagnostic accuracy facilitating management planning.

키워드

참고문헌

  1. Chowdhury FU, Shah N, Scarsbrook AF, et al (2010). [18F]FDG PET/CT imaging of colorectal cancer: a pictorial review. Postgrad Med J, 86, 174-82. https://doi.org/10.1136/pgmj.2009.079087
  2. Cipe G, Ergul N, Hasbahceci M, et al (2013). Routine use of positron-emission tomography/computed tomography for staging of primary colorectal cancer: does it affect clinical management? World J Surg Oncol, 11, 49. https://doi.org/10.1186/1477-7819-11-49
  3. Filippone A, Ambrosini R, Fuschi M, et al (2004). Preoperative T and N staging of colorectal cancer: accuracy of contrastenhanced multi-detector row CT colonography--initial experience. Radiol, 231, 83-90. https://doi.org/10.1148/radiol.2311021152
  4. Kantorova I, Lipska L, Belohlavek O, et al (2003). Routine (18)F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. J Nucl Med, 44, 1784-8.
  5. Liao CY, Chen SW, Wu YC, et al (2014). Correlations between 18F-FDG PET/CT parameters and pathological findings in patients with rectal cancer. Clin Nucl Med, 39, 40-5. https://doi.org/10.1097/RLU.0b013e318292f0f6
  6. Llamas-Elvira JM, Rodriguez-Fernandez A, Gutierrez-Sainz J, et al (2007). Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging, 34, 859-67. https://doi.org/10.1007/s00259-006-0274-4
  7. Moulton CA, Gu CS, Law CH, et al (2014). Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases: a randomized clinical trial. JAMA, 311, 1863-9. https://doi.org/10.1001/jama.2014.3740
  8. Niekel MC, Bipat S, Stoker J (2010). Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiol, 257, 674-84. https://doi.org/10.1148/radiol.10100729
  9. Park IJ, Kim HC, Yu CS, et al (2006). Efficacy of PET/CT in the accurate evaluation of primary colorectal carcinoma. Eur J Surg Oncol, 32, 941-7. https://doi.org/10.1016/j.ejso.2006.05.019
  10. Petersen RK, Hess S, Alavi A, et al (2014). Clinical impact of FDG-PET/CT on colorectal cancer staging and treatment strategy. Am J Nucl Med Mol Imaging, 4, 471-82.
  11. Selzner M, Hany TF, Wildbrett P, et al (2004). Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg, 240, 1027-34. https://doi.org/10.1097/01.sla.0000146145.69835.c5
  12. Shin SS, Jeong YY, Min JJ, et al (2008). Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. Abdom Imaging, 33, 270-7. https://doi.org/10.1007/s00261-007-9262-9
  13. Siegel R, Ma J, Zou Z, et al (2014). Cancer statistics, 2014. CA Cancer J Clin, 64, 9-29. https://doi.org/10.3322/caac.21208