The Clinical Study of ?(18)F-FDG PET/CT in Colorectal Cancer ...

[Abstract]

Objective The recurrence and metastasis of colorectal cancer post-operation arecommon, and they are also the major causes of the mortality. It is of great significancefor making the right therapeutic management decision to estimate whether there arerecurrence and metastasis or not, and to evaluate the extent of the patients with theknown diagnosises. At present, the clinical diagnosis information is mainly from thedetailed physical examination, serum CEA level, colonoscopy and the conventionalimaging modalities; however there is some limit in the diagnostic sensitivity andspeciality. Some researches have shown that ¹⁸F-FDG PET has some importantefficacy in the early diagnosis of the recurrent and metastatic colorectal cancer, in thedifferentiation between the postoperative scar and the tumor recurrence, in thepre-surgical accessment; anyway it is also a useful adjunct to the conventionalmodalities. We report our experience with the use of the whole-body ¹⁸F-FDGPET/CT in the patients with suspected recurrent and metastatic colorectal cancer, andthe patients with known diagnosises, to evaluate the clinical value of the ¹⁸F-FDGPET/CT in colorectal cancer post-operation.Materials and Methods Sixty-One patients with colorectal cancer post-operationwere examined with ¹⁸F-FDG PET/CT, 35 are males, 26 are females, age range 33?86years, mean age 60.4 years. Based on the indications of the examination with ¹⁸F-FDGPET/CT, there were four groups. Group 1, 6 patients were referred because of thesymptom and sign. Group 2, 14 patients were referred because of the inconclusiveresults of the conventional imaging modalities. Group 3, 30 patients were referredbecause of the elevation of serum CEA. Group 4, 11 patients had the knowndiagnosises. All patients were examined with Discovery LS PET/CT scanning ?GEMedical System?. Scan from the base of the skull through the midthigh. Low-dose CT scanning was performed first, PET scanning was performed immediately afteracquisition of the CT images, and the CT data were used for attenuation correction.PET images were reconstructed and fused with CT images, then displayed in threeorthogonal projections. Images were interpreted by two experienced imagingphysicians at the XELERIS workstation. All of the ¹⁸F-FDG uptakes in PET imageswere evaluated visually and semi-quantitatively using the standard uptake value?SUV?, PET images were read in conjunction with relevant the CT and the fusedimages. At last, making the diagnosis about whether there was recurrence andmetastasis or not for each patient, and reporting the position and the extent. Themeasurations of serum CEA and the conventional imaging examinations wereperformed within 4 weeks before the PET/CT examinations. The final diagnosiseswere confirmed by histopothology or by clinical course and conventional imagingmodalities follow-up whenever possible, the therapeutic decisions making were basedon the surgeons? advice. Comparing the results of PET/CT with the CEA levels, theconventional imaging examinations and the final diagnosises, calculating thesensitivity, specificity, accuracy, positive predictive value and the negative predictivevalue of PET/CT. At last analysising the changes of the patients? managements beforeand after the PET/CT examinations.Results The final diagnosises of the 61 patients, 25 had no recurrence or metastasis,and after the clinical follow-up for more than 12 months, the patients still survivedwithout disease. 11 had local recurrence or metastasis and 25 had extensive lesions,which were confirmed by histopathology or by conventional imaging modalitiesfollow-up. The results of ¹⁸F-FDG PET/CT examinations: 24 were diagnosis as norecurrence or metastasis?PET/CT found a focus FDG uptake in colon of two patientsrespectively, both were confirmed with adenoma; 1 patient was diagnosis as lungcancer by PET/CT, and who had a adenocarcinoma confirmed by histopathology?. 12were diagnosis as local recurrence and 25 were diagnosis as extensive metastasis.Comparing with the final diagnosises, PET/CT yielded a correct diagnosis in 58 out of 61 patients, 2 were false-positive?1 was due to chronic granuloma in abdominal wall,and 1 was due to inflammatory pseudotumor in lung?, 1 was false-negative ?due topresacral local microscopic recurrence?. The sensitivity, specificity, accuracy, PPVand NPV of PET/CT in detecting of recurrence or metastasis was 97.2%, 92.0%,95.1%, 94.6% and 95.8%, respectively. The changing results of the restages andclinical managements of the 36 patients: 17 patients had no changes. 2 patients hadchanges within the treatment modality. 15 patients, medical treatments were changedto surgry, or surgical to medical, or to no treatment. The correct changing rate ofPET/CT on the treatment decisions making in this study was 41.7%?15/36?. 1 patientwith falsely positive PET/CT finding was confirmed by histopothology, and 1 patientwith falsely negative PET/CT finding was confirmed by CT follow-up.Conclusion ¹⁸F-FDG PET/CT has some promising clinical value in the patients withcolorectal post-operation. ¹⁸F-FDG PET/CT is capable of identifying recurrence andmetastasis in the patients with unexplained rising CEA in the postoperativesurveillance of colorectal cancer, but with equal findings on conventional diagnosticmodalities. Making the differential diagnosis of the unspecific findings, which wereon the conventional imaging modalities. Determining the extent of the recurrence andmetastasis, helping the physicians implement the appropriate therapy. However, thereare still false-positive and false-negative diagnosises, combining the clinicalinformation and the low-dose CT examination can reduce the false diagnosises to thebest of our abilities.

Title: The Clinical Study of ?(18)F-FDG PET/CT in Colorectal Cancer Post-operation

Category: BMC Cancer

Filename: The Clinical Study of ?(18)F-FDG PET/CT in Colorectal Cancer Post-operation.pdf

Pages: 142

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