Value of FDG PET/Contrast-Enhanced CT in Initial Staging of Colorectal Cancer - Comparison with Contrast-Enhanced CT

Kunawudhi, Anchisa; Sereeborwornthanasak, Karun; Promteangtrong, Chetsadaporn; Siripongpreeda, Bunchorn; Vanprom, Saiphet; Chotipanich, Chanisa

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자료유형: 학술저널

저자정보: Kunawudhi, Anchisa (National Cyclotron and PET Centre, Chulabhorn Hospital) Sereeborwornthanasak, Karun (Radiology Department, Bhumibol Adulyadej Hospital) Promteangtrong, Chetsadaporn (National Cyclotron and PET Centre, Chulabhorn Hospital) Siripongpreeda, Bunchorn (Radiology Department, Bhumibol Adulyadej Hospital) Vanprom, Saiphet (National Cyclotron and PET Centre, Chulabhorn Hospital) Chotipanich, Chanisa (National Cyclotron and PET Centre, Chulabhorn Hospital)

저널정보: 아시아태평양암예방학회 Asian Pacific journal of cancer prevention : APJCP Asian Pacific journal of cancer prevention : APJCP 제17권 제8호

발행연도: 2016.1

수록면: 4,071 - 4,075 (5page)

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Background: FDG PET/CT is at an equivocal stage to recommend for staging of colorectal cancer as compared to contrast-enhanced CT (ceCT). This study was intended to evaluate the value of FDG PET/ceCT in colorectal cancer staging as compared to ceCT alone. Materials and Methods: PET/ceCT was performed for 61 colorectal cancer patients who were prospectively enrolled in the study. Three patients were excluded due to loss to follow-up. PET/ceCT findings and ceCT results alone were read separately. The treatment planning was then determined by tumor board consensus. The criteria for T staging were determined by the findings of ceCT. Nodal positive by PET/ceCT imaging was determined by visual analysis of FDG uptake greater than regional background blood pool activity. The diagnostic accuracy of T and N staging was determined only in patients who received surgery without any neoadjuvant treatment. Results: Of 58 patients, there were 40 with colon cancers including sigmoid cancers and 18 with rectal cancers. PET/ceCT in pre-operative staging detected bone metastasis and metastatic inguinal lymph nodes (M1a) that were undepicted on CT in 2 patients (3%), clearly defined 19 equivocal lesions on ceCT in 18 patients (31%) and excluded 6 metastatic lesions diagnosed by ceCT in 6 patients (10%). These resulted in alteration of management plan in 15 out of the 58 cases (26%) i.e. changing from chemotherapy to surgery (4), changing extent of surgery (9) and avoidance of futile surgery (2). Forty four patients underwent surgery within 45 days after PET/CT. The diagnostic accuracy for N staging with PET/ceCT and ceCT alone was 66% and 48% with false positive rates of 24% (6/25) and 76% (19/25) and false negative rates of 47% (9/19) and 21% (4/19), respectively. All of the false negative lymph nodes from PET/ceCT were less than a centimeter in size and located in peri-lesional regions. The diagnostic accuracy for T staging was 82%. The sensitivity of the peri-lesional fat stranding sign in determining T3 stage was 94% and the specificity was 54%. Conclusions: Our study suggested promising roles of PET/ceCT in initial staging of colorectal cancer with better diagnostic accuracy facilitating management planning.

#Colorectal cancer #pre-operative #staging #PET/CT #contrast-enhanced CT

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