Outcomes in Patients for Whom Discrepant PET Findings Were Inconsistent with Final Management
| Clinical indication and management type | PET findings and final validation | PET 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 later | Interpretive F−ve |
| Diagnostic laparoscopy (n = 1) | Prominent bowel activity presumed to be physiologic; small peritoneal metastases identified | F−ve |
| Observation (n = 3) | Multiple abnormalities in paraaortic region; multiple metastases confirmed by 6 mo | T+ve |
| Local recurrence in pelvis but biopsy-negative; progressive disease confirmed | T+ve | |
| Midabdominal uptake on PET, but patient refused follow-up | N/E | |
| Symptoms (n = 2) | ||
| Observation | Local relapse confirmed | T+ve |
| Diagnostic laparoscopy | No abnormality; multiple tiny peritoneal deposits found | F−ve |
| Isolated metastases (n = 6) | ||
| Supportive care (n = 2) | Isolated liver metastasis; additional disease in liver on CT arterial portography and follow-up CT | T+ve* |
| Isolated liver metastasis; multiple metastases at laparotomy | T+ve* | |
| Radiotherapy | Biopsy-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 CT | F−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 metastasis | F−ve |
↵* Underestimated extent of metastatic disease.
T+ve = true-positive; F+ve = false-positive; F−ve = false-negative; N/E = not evaluable.