Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver

• Published in: The American journal of surgery Vol. 171; no. 1; pp. 21 - 26
• Main Authors: Vitola, João V., Delbeke, Dominique, Sandler, Martin P., Campbell, Michelle G., Powers, Thomas A., Wright, J. Kelly, Chapman, William C., Pinson, C. Wright
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 1996; Elsevier Limited
• Subjects: Cancer; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; Computed tomography; Deoxyglucose - analogs & derivatives; Female; Fluorine isotopes; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Imaging techniques; Lesions; Liver; Liver diseases; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medical imaging; Metabolism; Metastases; Metastasis; Middle Aged; Neoplasm Staging - methods; Positron emission; Positron emission tomography; Sensitivity and Specificity; Tomography; Tomography, Emission-Computed; Tomography, X-Ray Computed
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)80067-1

Accurate detection of recurrent colorectal carcinoma remains a clinical challenge. Positron emission tomography (PET) using
18F-fluorodeoxyglucose (
18FDG) is an imaging technique that allows direct evaluation of cellular metabolism.
18F-fluorodeoxyglucose PET was compared to computed tomography (CT) and CT portography for staging metastatic colorectal carcinoma.
Twenty-four patients previously treated for colorectal carcinoma who had suspected recurrence to the liver underwent an
18FDG PET scan of the entire body. All patients had either a CT scan of the abdomen (n = 17), a CT portogram (n = 18), or both (n = 11). The final diagnosis was obtained by tissue pathology in 19 patients and clinical follow-up in 5 patients.
A total of 60 suspicious lesions were identified. Of the 55 intrahepatic lesions, 39 were malignant and 16 were benign. Of the 5 extrahepatic lesions, 4 were malignant. The
18FDG PET imaging had a higher accuracy (93%) than CT and CT portography (both 76%) in detecting metastatic disease to the liver, and detected unsuspected extrahepatic recurrence in 4 patients. Although the sensitivity of
18FDG PET (90%) was slightly lower than that of CT portography (97%), the specificity was much higher (100% versus 9%), including postsurgical sites.
18FDG PET altered surgical plans in 6 (25%) of 24 patients.
18FDG PET is extremely useful in staging patients with suspected metastatic colorectal carcinoma to the liver.