Scientific paper
Is 18F-fluorodeoxyglucose positron emission tomography in recurrent colorectal cancer a contribution to surgical decision making?

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Abstract

Background: Accuracy of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contribution to surgical decision making in recurrent or metastatic colorectal cancer were evaluated.

Methods: One hundred whole-body PET tests in colorectal cancer patients (1994 to 1998) were compared with computed tomography (CT), liver ultrasonography, and carcinoembryonic antigen (CEA) test. Mean follow-up was 12 months.

Results: Sensitivity, specificity, and accuracy of FDG-PET for malignant findings were, respectively, 98%, 90% and 95%; for 87 CT scans, 91%, 72%, and 82%; for 98 CEA tests, 76%, 90%, and 82%; for detection of liver metastases with PET, 100%, 99%, and 99%; and for 68 ultrasound tests, 87%, 96%, and 93%. PET accuracy for local recurrence was 96%. Additional information was provided by PET in 86% of cases (abdomen, thorax, liver). PET influenced surgical decisions in 61% of cases.

Conclusion: FDG-PET adds relevant accuracy to the conventional staging of patients with colorectal cancer and may cost-effectively help to select the appropriate treatment.

Section snippets

Patients

A total of 100 patients (mean age 62 years, range 32 to 80; 42 women, 58 men) with histologically proven colon (n = 45) or rectal (n = 55) cancer who were treated in the Department of General Surgery, University of Ulm, Germany, were included in the study after informed consent. The study protocol had been approved by the university’s ethics review board. Patients were documented prospectively during the period between January 1, 1994, and December 31, 1998, and followed up with the

Results

In 100 patient examinations, FDG-PET (Table I)showed a sensitivity of 98% and a specificity of 90% in the detection of malignancy in recurrent or metastasized colorectal cancer compared with CT and CEA. In PET, there were 4 false positive results and 1 false negative result. False positive PET results were seen in thorax (2 lung metastases in patients undergoing adjuvant immunotherapy) and pelvis scans (1 anastomosis recurrence after rectal resection and adjuvant immunotherapy; 1 anastomosis

Comments

The spectrum of colorectal cancer patients included in this study represents characteristic cohorts that might cause problems for the surgeon in defining the correct therapy strategy. On the one hand, surgery of metastases is not beneficial in patients with disseminated disease (sensitivity problem); on the other hand, systemic chemotherapy in patients with suspected (but not proven) tumor dissemination will withhold them from a potentially curative resection (specificity problem).

Because of

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