Scientific Online Resource System

Scripta Scientifica Medica

Value the FDG-PET/CT on the management of colorectal cancer patients

A. Tonev, N. Kolev, V. Ignatov, G. Ivanov, A. Zlatarov, K. Ivanov


INTRODUCTION: In patients with colorectal cancer (CRC), preoperative evaluation and staging should focus on techniques that might alter the preoperative or intraoperative surgical plan. Conventional imaging methods (CT, MRI) have low accuracy for identifying the depth of tumour infiltration and have limited ability to detect regional lymph node involvement. The aim of this study was to evaluate the utility of FDG-PET in the initial staging of patients with CC in comparison with conventional staging methods and to determine its impact on therapeutic management.

METHODS: In First Clinic of Surgery at University Hospital `St. Marina` one hundred and four patients with a diagnosis of CRC (53 males and 51 females; mean age 66.76± 12.36 years), selected prospectively. All patients were studied for staging using a standard procedure (CT) and

FDG-PET. The reference method was histology. The effect of FDG-PET on diagnoses and the operative treatment was studied.

RESULTS: In 14 patients, surgery was contraindicated by FDG-PET owing to the extent of disease (only 6/14 suspected by CT). FDG-PET revealed four synchronous tumours. For N staging, both procedures showed a relatively high specificity but a low diagnostic accuracy (PET 56%, CT 60%) and sensitivity (PET 21%, CT 25%). For M assessment, diagnostic accuracy was 92% for FDGPET and 87% for CT. FDG-PET results led to modification of the therapy approach in 17.85% of the patients with rectal cancer and in 14.8% of the patients with colon cancer.

CONCLUSION: Compared with conventional techniques, FDGPET appears to be useful in pre-surgical staging of CC, revealing unsuspected disease and impacting on the treatment approach.

Full Text


Skibber JM, Minsky BD, Hoff PM. Can cer of the co - lon. In: DeVita VT, Hellman S, Rosenberg SA, ed i - tors. Can cer. Prin ci ples and prac tice of on col ogy. Phil a del phia: Lippincott, Wil liams &Wilkins; 2001; p. 1216-71.

Co hen AM. Pre op er a tive eval u a tion of pa tients with pri mary co lon can cer. Can cer 1992;70:1328-72.

Bleeker WA, Mulder NH, Hermans J, Ot ter R, Plukker JT. Valueand cost of fol low-up af ter adjuvant treat ment of pa tients withDukes` C co lonic can cer. Br J Surg 2001;88:101-6.

Geoghegans JG, Scheele J. Treat ment of colorectal liver metastases. Br J Surg 1999;86:158-69.

Brown G, Hus band JE, Cook G. Colorectal can cer. In: Hus band JE, Reznek RH, ed i tors. Im ag ing in on - col ogy. Lon don: Tay lor & Fran cis; 2004; p. 217-43.

Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, et al. Five-year sur vival fol low ing hepatic re sec tion al ter neoadjuvant ther apy for nonresectable colorectal. Ann Surg Oncol 2001;8:347-53.

Clavien PA, Selzner N, Morse M, Selzner M, Paulson E. Downstaging of hepatocellular car ci noma and liver metastases 866 Eur J Nucl Med Mol Im ag ing (2007) 34:859-867 from colorectal can cer by se lec tive intra-arterial chemotherapy. Surgery 2002;131:433-42.

Cook GJR. Ar ti facts and nor mal vari ants in whole-body PET im ag ing. In: Valk PE, Bailey DL, Townsend DW, Maisey MN, ed i tors. Pos i tron emis - sion tomography. Basic science and clinical practice. Lon don: Springer; 2003; p. 495-505.

Cabrera Villegas A, Gamez Cenzano C, Mar tin Urreta JC. Tomografía por emisión de positrones (PET) en oncología clínica. Rev Esp Med Nu clear 2002;2:131-47.

Rodríguez Fernández A, Gómez Río M, Lla - mas-Elvira JM, Ortega-Lozano S, Ferron-Orihuela JA, Ramia-An gel JM, et al. Positronemission to mog - ra phy with flu o rine-18-fluoro-2-deoxy-D-glu cose for gallbladder can cer di ag no sis. Am J Surg 2004;188:171-5.

Tanaka T, Kawai Y, Kanai M, Taki Y, Nakamoto Y, Takabayashi A. Use ful ness of FDG-pos i tron emis sion to mog ra phy in di ag nos ing peritoneal re cur rence of colorectal can cer. Am J Surg 2002;184:433-6.

Kinkel K, Lu Y, Both M, War ren RS, Thoeni R. De - tec tion of hepatic metastases from can cers of the gas - tro in tes ti nal tract by us ing non-in va sive im ag ing meth ods (US, CT, MR Im ag ing, PET): a meta-anal y - sis. Ra di ol ogy 2002;224:748-56.

Huebner RH, Park KC, Shep herd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-anal y sis of the lit er a ture for whole-body FDG PET de tec tion of re - cur rent colorectal can cer. J Nucl Med 2000;41:1177-89.

Abdel Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantowicz PJ, Carbone GM, et al. Stag ing of pri - mary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: cor re la tion with histopathologic and CT find ings. Ra di ol ogy 1998;206:755-60.

Mukai M, Sadahiro S, Yasuda S, Ishida H, Tokunaga N, Tajima T, et al. Preoperative evaluation by whole-body 18F-fluorodeoxyglucose pos i tron emis - sion to mog ra phy in pa tients with pri mary colorectal can cer. Oncol Rep 2000;7:85-7.

Kantorova I, Lipska L, Belohlavek O, Visokai V, Trubac M,Schneiderova M. Rou tine 18F-FDG-PET preoperative staging of colorectal cancer: comparison with con ven tional stag ing and its im pact on treat ment de ci sion mak ing. J Nucl Med 2003;44:1784- 8.

Debois JM. TxNxM1: The anat omy and clin ics of metastastic can cer. Part II: The pri mary and its metastases. Boston: Kluwer Ac a demic; 2002; p. 366-97.

Bipat S, van Leeuwen MS, Comans EFI, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR im ag ing and PET for di ag no - sis-meta-anal y sis. Ra di ol ogy 2005;237:123-31.

Amer i can Joint Com mit tee on Can cer. AJCC Can cer Stag ing Man ual, 6th edi tion. Berlin Hei del berg, New York: SPringer; 2002; p. 113-23.

Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PM, Stoker J. Rec tal can cer: lo cal stag ing and as sess ment of lymph node in volve ment with endoluminal US, CT, and MR im ag ing- a meta-anal y sis. Ra di ol ogy 2004;232:773-83.

Delbeke D, Mar tin WH. PET and PET-CT for eval u a - tion of colorectal car ci noma. Semin Nucl Med 2004;34:209-33.

Car ring ton BM. Lymph node metastases. In: Hus band JES, Reznek RH, ed i tors. Im ag ing in on col ogy. Lon - don: Tay lor & Fran cis; 2004; p. 999-1022.

Bjelovic M, Kalezic V, Petrovic M, Pesko P, Usaj SK, Marinkovic J, et al. Cor re la tion of mac ro scopic and histological char ac ter is tics in the re gional lymph nodes of pa tients with rec tal and sigmoidal adenocarcinoma. Hepatogastroenterology 1998;45:433-8.

Beets-Tan RGH, Beets GL. Rec tal can cer: re view with em pha sis on MR im ag ing. Ra di ol ogy 2004;232:335-46.

Vitola JV, Delbeke D, Sandler MP, Camp bell MG, Pow ers TA, Wright JK, et al. Pos i tron emis sion to - mography to stage suspected metastatic colorectal car ci noma to the liver. Am J Surg 1996;171:21-6.

Boykin KN, Zibari GB, Lilien DL, McMillan RW, Aultman DF, Mc Don ald JC. The use of FDG-pos i tron emis sion to mog ra phy for the eval u a tion of colorectal metastases to the liver. Am Surg 1999;65:1183-5.

Rohren EM, Turkington TG, Coleman RE. Clin i cal ap pli ca tions of PET in on col ogy. Ra di ol ogy 2004;231:305-32.

Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Sur vival of pa tients eval u ated by FDG-PET be fore hepatic re sec tion for met a static colorectal carcinoma: a prospective database study. Ann Surg 2001;233:293-9.

Rohren EM, Paulson EK, Hagge R, Wong TZ, Killius J, Clavien PA, et al. The role of 18F-FDG PET in pre - op er a tive as sess ment of the liver in pa tients be ing con sid ered for cu ra tive re sec tion of hepatic metastases from colorectal can cer. Clin Nucl Med 2002;27:550-556



Article Tools
Email this article (Login required)
About The Authors

A. Tonev
Ist Clinic ot surgery, University hospital St. Marina of Varna

N. Kolev
Ist Clinic ot surgery, University hospital St. Marina of Varna

V. Ignatov
Ist Clinic ot surgery, University hospital St. Marina of Varna

G. Ivanov
Ist Clinic ot surgery, University hospital St. Marina of Varna

A. Zlatarov
Ist Clinic ot surgery, University hospital St. Marina of Varna

K. Ivanov
Ist Clinic ot surgery, University hospital St. Marina of Varna

Font Size