Skip to main content

Advertisement

SpringerLink
Log in

Impact of positron emission tomography on strategy in liver resection for primary and secondary liver tumors

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Outcome of patients with metastatic disease mainly depends on accurate preoperative tumor staging. 18[F]fluorodeoxyglucose positron emission tomography (18F-PET) has been proven to be a valuable diagnostic tool in a number of different tumors but its direct influence on liver surgery has not been thoroughly investigated.

Materials and methods

Between July 1999 and March 2000, 50 consecutive patients with 174 suspected liver lesions were admitted to the University Hospital Jena. All 50 patients underwent abdominal ultrasound, CT-scan, and 18-FDG positron emission tomography scanning. In 23 patients the diagnostic work-up was completed by MRI scan.

Results

Altogether there were a total of 174 histologically proven intrahepatic lesions, nine of which were benign. The sensitivity, specificity, and positive predictive value of PET for all hepatic lesions was 82%, 25%, and 96% compared with 63%, 50%, and 96% for abdominal ultrasound, 71%, 50%, and 97% for CT-scan, and 83%, 57%, and 97% for MRI-scan. In 23 of 50 patients 24 extrahepatic lesions were identified. In these patients the sensitivity and specificity of PET—compared to abdominal ultrasound, CT-scan, and MRI-scan for all extrahepatic lesions—was 63% and 60%, 29% and 25%, 47% and 50% and 40% and 50%, respectively. The findings on PET scan had a direct impact on operative management in nine patients (18%).

Conclusions

Our series demonstrates good sensitivity and specificity for the detection of primary and secondary liver lesions which is superior to ultrasound and CT scan but not to MRI scan. The main value of PET scan consists in the detection of extrahepatic tumor (64%). Due to better detection of extrahepatic tumor, FDG-PET is a very useful addition to the currently used anatomically-based images in all cases of advanced tumor spread with high risk of extrahepatic tumor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boykin KN, Zibari GB, Lilien DL, McMillan RW, Aultman DF, McDonald JC (1999) The use of FDG-positron emission tomography for the evaluation of colorectal metastases of the liver. Am Surg 65:1183–1185

    CAS  PubMed  Google Scholar 

  2. Fong Y, Saldinger PF, Akhurst T, Macapinlac H, Yeung H, Finn RD, Cohen A, Kemeny N, Blumgart LH, Larson SM (1999) Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am J Surg 178:282–287

    Article  CAS  PubMed  Google Scholar 

  3. Delbeke D, Vitola JV, Sandler MP, Arildsen RC, Powers TA, Wright JK Jr, Chapman WC, Pinson CW (1997) Staging recurrent metastatic colorectal carcinoma with PET. J Nucl Med 38:1196–1201

    CAS  PubMed  Google Scholar 

  4. Ogunbiyi OA, Flanagan FL, Dehdashti F, Siegel BA, Trask DD, Birnbaum EH, Fleshman JW, Read TE, Philpott GW, Kodner IJ (1997) Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and computed tomography. Ann Surg Oncol 4:613–620

    CAS  PubMed  Google Scholar 

  5. Lewis PJ, Salama A (1994) Uptake of fluorine-18-fluorodeoxyglucose in sarcoidosis. J Nucl Med 35:1647–1649

    CAS  PubMed  Google Scholar 

  6. Lai DT, Fulham M, Stephen MS, Chu KM, Solomon M, Thompson JF, Sheldon DM, Storey DW (1996) The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver. Arch Surg 131:703–707

    CAS  PubMed  Google Scholar 

  7. Hughes KS, Simon R, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, Maclean BJ, Foster JH, Daly JM, Fitzherbert D (1986) Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery 100:278–284

    CAS  PubMed  Google Scholar 

  8. Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ (1984) Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg 199:306–316

    CAS  PubMed  Google Scholar 

  9. August DA, Sugarbaker PH, Ottow RT, Gianola FJ, Schneider PD (1985) Hepatic resection of colorectal metastases. Influence of clinical factors and adjuvant intraperitoneal 5-fluorouracil via Tenckhoff catheter on survival. Ann Surg 201:210–218

    CAS  PubMed  Google Scholar 

  10. Fischman AJ (1996) Positron emission tomography in the clinical evaluation of metastatic cancer. J Clin Oncol 14:691–696

    CAS  PubMed  Google Scholar 

  11. Collins BT, Lowe VJ, Dunphy FR (1999) Correlation of CT-guided fine-needle aspiration biopsy of the liver with fluoride-18 fluorodeoxyglucose positron emission tomography in the assessment of metastatic hepatic abnormalities. Diagn Cytopathol 21:39–42

    Article  CAS  PubMed  Google Scholar 

  12. Lowe VJ, Fletcher JW, Gobar L, Lawson M, Kirchner P, Valk P, Karis J, Hubner K, Delbeke D, Heiberg EV, Patz EF, Coleman RE (1998) Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 16:1075–1084

    CAS  PubMed  Google Scholar 

  13. Pasquali C, Rubello D, Sperti C, Gasparoni P, Liessi G, Chierichetti F, Ferlin G, Pedrazzoli S (1998) Neuroendocrine tumor imaging: can 18F-fluorodeoxyglucose positron emission tomography detect tumors with poor prognosis and aggressive behavior? World J Surg 22:588–592

    Article  CAS  PubMed  Google Scholar 

  14. Wong WL, Chevretton EB, McGurk M, Hussain K, Davis J, Beaney R, Baddeley H, Tierney P, Maisey M (1997) A prospective study of PET-FDG imaging for the assessment of head and neck squamous cell carcinoma. Clin Otolaryngol 22:209–214

    CAS  PubMed  Google Scholar 

  15. Moss AA (1989) Imaging of colorectal carcinoma. Radiology 170:308–310

    CAS  PubMed  Google Scholar 

  16. Flier JS, Mueckler MM, Usher P, Lodish HF (1987) Elevated levels of glucose transport and transporter messenger RNA are induced by ras or src oncogenes. Science 235:1492–1495

    CAS  PubMed  Google Scholar 

  17. Monakhov NK, Neistadt EL, Shavlovskil MM, Shvartsman AL, Neifakh SA (1978) Physicochemical properties and isoenzyme composition of hexokinase from normal and malignant human tissues. J Natl Cancer Inst 61:27–34

    CAS  PubMed  Google Scholar 

  18. Reske SN (1999) Current status of positron emission tomography in diagnosis of abdominal tumors. Schweiz Rundsch Med Prax 88:52–58

    CAS  PubMed  Google Scholar 

  19. Kurtaran A, Becherer A, Pfeffel F, Muller C, Traub T, Schmaljohann J, Kaserer K, Raderer M, Schima W, Dudcak R, Kletter K, Virgolini I (2000) 18F-fluorodeoxyglucose (FDG)-PET features of focal nodula hyperplasia (FNH) of the liver. Liver 20:487–490

    Article  CAS  PubMed  Google Scholar 

  20. Frohlich A, Diederichs CG, Staib L, Vogel J, Beger HG, Reske SN (1999) Detection of liver metastases from pancreatic cancer using FDG-PET. J Nucl Med 40:250–255

    Google Scholar 

  21. Trojan J, Schroeder O, Raedle J, Baum RP, Herrmann G, Jacobi V, Zeuzem S (1999) Fluorine-18 FDG positron emission tomography for imaging of hepatocellular carcinoma. Am J Gastroenterol 94:3314–3319

    Article  CAS  PubMed  Google Scholar 

  22. Iwata Y, Shiomi S, Sasaki N, Jomura H, Nishiguchi S, Seki S, Kawabe J, Ochi H (2000) Clinical usefulness of positron emission tomography with fluorine-18-fluorodeoxyglucose in the diagnosis of liver tumors. Ann Nucl Med 14:121–126

    Google Scholar 

  23. Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, Collins BT, Di Bisceglie AM (2000) Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 32:792–797

    Article  CAS  PubMed  Google Scholar 

  24. Jadvar H, Segall GM (1997) False-negative fluorine-18-FDG PET in metastatic carcinoid. J Nucl Med 38:1382–1383

    Google Scholar 

  25. Moehler M, Dimitrakopoulou-Strauss A, Gutzler F, Raeth U, Strauss LG, Stremmel W (1998) 18F-labeled fluorouracil positron emission tomography and the prognoses of colorectal carcinoma patients with metastases to the liver treated with 5-fluorouracil. Cancer 83:245–253

    CAS  PubMed  Google Scholar 

  26. Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246

    PubMed  Google Scholar 

  27. Moertel CG (1994) Chemotherapy for colorectal cancer. N Engl J Med 330:1136–1142

    Article  CAS  PubMed  Google Scholar 

  28. Vitola JV, Delbeke D, Meranze SG, Mazer MJ, Pinson CW (1996) Positron emission tomography with F-18-fluorodeoxyglucose to evaluate the results of hepatic chemoembolization. Cancer 1578:2216–2222

    Article  Google Scholar 

  29. Dimitrakopoulou-Strauss A, Strauss LG, Schlag P, Hohenberger P, Mohler M, Oberdorfer F, van Kaick G (1998) Fluorine-18-fluorouracil to predict therapy response in liver metastases from colorectal carcinoma. J Nucl Med 39:1197–1202

    CAS  PubMed  Google Scholar 

  30. Widjaja A, Mix H, Wagner S, Graz KF, van den Hoff J, Petrich T, Meier PN, Manns MP (1999) Positron emission tomography and cholangiocarcinoma in primary sclerosing cholangitis. Z Gastroenterol 37:731–733

    CAS  PubMed  Google Scholar 

  31. Frohlich A, Diederichs CG, Staib L, Vogel J, Beger HG, Reske SN (1999) Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 40:250–255

    Google Scholar 

  32. Patel PM, Alibazoglu H, Ali A, Fordham E, LaMonica G (1997) False-positive’ uptake of FDG in a hepatic adenoma. Clin Nucl Med 22:490–491

    Article  CAS  PubMed  Google Scholar 

  33. Schluter B, Grimm-Riepe C, Beyer W, Lubeck M, Schirren-Bumann K, Clausen M (1998) Histological verification of positive fluorine-18 fluorodeoxyglucose findings in patients with differentiated thyroid cancer. Langenbecks Arch Surg 383:187–189

    CAS  PubMed  Google Scholar 

  34. Dimitrakopoulou-Strauss A, Strauss LG, Goldschmidt H, Lorenz WJ, Maier-Borst W, van Kaick G (1995) Evaluation of tumour metabolism and multidrug resistance in patients with treated malignant lymphomas. Eur J Nucl Med 22:434–442

    CAS  PubMed  Google Scholar 

  35. Findlay M, Young H, Cunningham D, Iveson A, Cronin B, Hickish T, Pratt B, Husband J, Flower M, Ott R (1996) Noninvasive monitoring of tumor metabolism using fluorodeoxyglucose and positron emission tomography in colorectal cancer liver metastases: correlation with tumor response to fluorouracil. J Clin Oncol 14:700–708

    CAS  PubMed  Google Scholar 

  36. Torizuka T, Tamaki N, Inokuma T, Magata Y, Yonekura Y, Tanaka A, Yamaoka Y, Yamamoto K, Konishi J (1994) Value of fluorine-18-FDG-PET to monitor hepatocellular carcinoma after interventional therapy. J Nucl Med. 35:1965–1969

    Google Scholar 

  37. Kubota K, Matsuzawa T, Fujiwara T, Ito M, Hatazawa J, Ishiwata K, Iwata R, Ido T (1990) Differential diagnosis of lung tumor with positron emission tomography: a prospective study. J Nucl Med 31:1927–1932

    CAS  PubMed  Google Scholar 

  38. Minn H, Lapela M, Klemi PJ, Grenman R, Leskinen S, Lindholm P, Bergman J, Eronen E, Haaparanta M, Joensuu H (1997) Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 38:1907–1911

    CAS  PubMed  Google Scholar 

  39. Schirrmeister H, Kuhn T, Guhlmann A, Santjohanser C, Horster T, Nussle K, Koretz K, Glatting G, Rieber A, Kreienberg R, Buck AC, Reske SN (2001) Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med 28:351–358

    Google Scholar 

  40. Rostom AY, Powe J, Kandil A, Ezzat A, Bakheet S, el-Khwsky F, el-Hussainy G, Sorbris R, Sjoklint O (1999) Positron emission tomography in breast cancer: a clinicopathological correlation of results. Br J Radiol 72:1064–1068

    CAS  PubMed  Google Scholar 

  41. Grab D, Flock F, Stohr I, Nussle K, Rieber A, Fenchel S, Brambs HJ, Reske SN, Kreienberg R (2000) Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 77:454–459

    Article  CAS  PubMed  Google Scholar 

  42. Nakamoto Y, Saga T, Ishimori T, Mamede M, Togashi K, Higuchi T, Mandai M, Fujii S, Sakahara H, Konishi J (2001) Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. AJR Am J Roentgenol 176:1449–1454

    CAS  PubMed  Google Scholar 

  43. Schroder W, Zimny M, Rudlowski C, Bull U, Rath W (1999) The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET) in diagnosis of ovarian cancer. Int J Gynecol Cancer 9:117–122

    Article  PubMed  Google Scholar 

  44. Ishiko O, Honda K, Hirai K, Sumi T, Ogita S, Koyama K, Kawabe J, Ochi H (2001) Diagnosis of metastases of ovarian clear cell carcinoma to the peritoneum of the abdominal wall by positron emission tomography with (fluorine-18)-2-deoxyglucose. Oncol Rep 8:67–69

    CAS  PubMed  Google Scholar 

  45. Umesaki N, Tanaka T, Miyama M, Kawamura N, Ogita S, Kawabe J, Okamura T, Koyama K, Ochi H (2001) Positron emission tomography with (18)F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging. Gynecol Oncol 80:372–377

    Article  CAS  PubMed  Google Scholar 

  46. Machado MC, Cunha JE, Penteado S, Bacchella T, Jukemura J, Costa AC, Halpern-Salomon I (2000) Preoperative diagnosis of pancreatic leiomyosarcoma. Int J Pancreatol 28:97–100

    Article  CAS  PubMed  Google Scholar 

  47. Thurer RL, Thorsen A, Parker JA, Karp DD (2000) FDG imaging of a pulmonary artery sarcoma. Ann Thorac Surg 70:1414–1415

    Article  CAS  PubMed  Google Scholar 

  48. Babatasi G, Massetti M, Agostini D, Galateau F, Le Page O, Saloux E, Bhoyroo S, Grollier G, Potier JC, Khayat A (1998) Leiomyosarcoma of the heart and great vessels. Ann Cardiol Angeiol (Paris) 47:451–458

    Google Scholar 

  49. Beets G, Penninckx F, Schiepers C, Filez L, Mortelmans L, Kerremans R, Aerts R, De Roo M (1994) Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer. Br J Surg 81:1666–1670

    CAS  PubMed  Google Scholar 

  50. Ak I, Stokkel MP, Pauwels EK (2000) Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose in oncology. Part II. The clinical value in detecting and staging primary tumours. J Cancer Res Clin Oncol 126:560–574

    CAS  PubMed  Google Scholar 

  51. McDaniel KP, Charnsangavej C, DuBrow RA, Varma DG, Granfield CA, Curley SA (1993) Pathways of nodal metastasis in carcinomas of the cecum, ascending colon, and transverse colon: CT demonstration. AJR Am J Roentgenol 161:61–64

    Google Scholar 

  52. Turk PS, Wanebo HJ (1993) Results of surgical treatment of nonhepatic recurrence of colorectal carcinoma. Cancer 71[Suppl 12]:4267–4277

  53. Greenway B (1988) Hepatic metastases from colorectal cancer: resection or not. Br J Surg 75:513–519

    CAS  PubMed  Google Scholar 

  54. Sugarbaker PH, Kemeny N (1989) Management of metastatic cancer to the liver. Adv Surg 22:1–56

    CAS  PubMed  Google Scholar 

  55. Bartolozzi C, Lencioni R, Donati F, Cioni D (2000) Abdominal MR: liver and pancreas. Syll. MRI – from basic knowledge to advanced strategies. Categorical Course European Congress of Radiology, March 5–10, Vienna. pp 121–137

    Google Scholar 

  56. Itai Y, Matsui O (1997) Blood flow and liver imaging. Radiology 202:306–314

    CAS  PubMed  Google Scholar 

  57. Itai Y, Saida Y (2002) Pitfalls in liver imaging. Eur Radiol 12:1162–1174

    Article  PubMed  Google Scholar 

  58. Rummeny EJ, Marchal G (1997) Liver imaging: clinical applications and future perspectives. Acta Radiol 38:626–630

    CAS  PubMed  Google Scholar 

  59. VanBeers BE, Gallezz B, Pringot J (1997) Contrast-enhanced MR-imaging of the liver. Radiology 203:297–306

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany

    B. Böhm

  2. Department of General and Visceral Surgery, Friedrich-Schiller-University, Jena, Germany

    J. Geoghegan, H. Hellfritzsch & J. Scheele

  3. Department of Nuclear Medicine, Friedrich-Schiller-University, Jena, Germany

    M. Voth & D. Gottschild

  4. Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University, Jena, Germany

    A. Petrovich

Authors
  1. B. Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Voth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Geoghegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Hellfritzsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Petrovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Scheele
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Gottschild
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Böhm, B., Voth, M., Geoghegan, J. et al. Impact of positron emission tomography on strategy in liver resection for primary and secondary liver tumors. J Cancer Res Clin Oncol 130, 266–272 (2004). https://doi.org/10.1007/s00432-003-0527-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-003-0527-6

Keywords

Search

Navigation