OtherClinical Investigations

The Clinical Impact of 18F-FDG PET in Patients with Suspected or Confirmed Recurrence of Colorectal Cancer: A Prospective Study

Victor Kalff, Rodney J. Hicks, Robert E. Ware, Annette Hogg, David Binns and Allan F. McKenzie
Journal of Nuclear Medicine April 2002, 43 (4) 492-499;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Both CT and 18F-FDG PET suggested presence of single hepatic metastasis. At laparotomy, additional small (<1 cm) metastases were found and hepatic resection was abandoned.

  • FIGURE 2.
    FIGURE 2.

    This patient was being considered for resection of an apparently isolated lung metastasis. In addition to lung lesion shown in upper panel, PET found additional multiple liver metastases not apparent on CT, as shown in lower panel. Surgery was avoided, and abdominal metastases were subsequently confirmed by serial imaging.

Tables

  • TABLE 1

    Management Changes Influenced by PET by Clinical Indication

    Management change influenced by PETLimited metastases (n = 34)Rising markers (n = 20)Symptoms (n = 17)New mass (n = 12)Disease extent (n = 11)Residual mass (n = 8)Total (n = 102)
    Treatment planning*0020406
    Active to observation0030025
    Active to supportive71300011
    Observation to active010100112
    Varied active132351226
    Total changed20 (59)13 (65)12 (71)5 (42)5 (45)5 (63)60 (59)

    • ↵* Patients for whom referring clinician was not prepared to prospectively commit to a treatment plan without access to PET findings.

    • Numbers in parentheses are percentages.

  • TABLE 2

    Summary of Impact of PET on Aggressive Local Therapies by Clinical Indication

    TreatmentLimited metastasesRising markersSymptomsNew massDisease extentResidual massTotal
    Surgery prevented191220226
    Radiotherapy prevented1031005
    Total prevented20153231
    Surgery initiated0700018
    Radiotherapy initiated23211110
    Total initiated210211218
  • TABLE 3

    Validation of PET Results in 60 Patients for Whom PET Altered Management

    Clinical indicationPET result categoryTotal
    T+veF+veT−veF−veN/E
    Treatment planning*426
    Active to observation55
    Active to supportive9211
    Observation to active101†112
    Varied active2626
    Total49‡17360

    • ↵* Patients for whom referring clinician was not prepared to prospectively commit to a treatment plan without access to PET findings.

    • ↵† Pelvic abscess was diagnosed and drained at laparotomy.

    • ↵‡ Includes 4 patients for whom PET underestimated disease extent.

    • T+ve = true-positive; F+ve = false-positive; T−ve = true-negative; F−ve = false-negative; N/E = not evaluable.

  • TABLE 4

    Outcomes in Patients for Whom Discrepant PET Findings Were Inconsistent with Final Management

    Clinical indication and management typePET findings and final validationPET result
    New or residual mass
     Surgery as planned (n = 5)Multifocal disease proven inoperable at laparotomy (n = 4)4 T+ve
    Suspected granulomatous mediastinal disease in addition to abdominal disease; no progressive abnormality in mediastinum over 1 y (n = 1)F+ve
    Rising CEA (n = 5)
     Surgery (n = 1)Presumed physiologic activity in stomach subsequently reinterpreted as metastasis on direct correlation with previously unavailable but reportedly normal CT findings; patient underwent hepatic resection and remained well >12 mo laterInterpretive F−ve
     Diagnostic laparoscopy (n = 1)Prominent bowel activity presumed to be physiologic; small peritoneal metastases identifiedF−ve
     Observation (n = 3)Multiple abnormalities in paraaortic region; multiple metastases confirmed by 6 moT+ve
    Local recurrence in pelvis but biopsy-negative; progressive disease confirmedT+ve
    Midabdominal uptake on PET, but patient refused follow-upN/E
    Symptoms (n = 2)
     ObservationLocal relapse confirmedT+ve
     Diagnostic laparoscopyNo abnormality; multiple tiny peritoneal deposits foundF−ve
    Isolated metastases (n = 6)
     Supportive care (n = 2)Isolated liver metastasis; additional disease in liver on CT arterial portography and follow-up CTT+ve*
    Isolated liver metastasis; multiple metastases at laparotomyT+ve*
     RadiotherapyBiopsy-proven and apparently isolated liver metastasis on CT not visualized on PET, but poor study because of patient obesity; additional disease in liver on CT arterial portography and follow-up CTF−ve
     Surgery as planned (n = 3)Extrahepatic metastases; inoperable as suspected by PET (n = 2)2 T+ve
    Solitary <1-cm liver metastasis on CT not seen on PET; confirmed solitary metastasisF−ve

    • ↵* Underestimated extent of metastatic disease.

    • T+ve = true-positive; F+ve = false-positive; F−ve = false-negative; N/E = not evaluable.

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