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Zirakchian Zadeh M. PET/CT in assessment of colorectal liver metastases: a comprehensive review with emphasis on 18F-FDG. Clin Exp Metastasis 2023; 40:465-491. [PMID: 37682423 DOI: 10.1007/s10585-023-10231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Approximately 25% of those who are diagnosed with colorectal cancer will develop colorectal liver metastases (CRLM) as their illness advances. Despite major improvements in both diagnostic and treatment methods, the prognosis for patients with CRLM is still poor, with low survival rates. Accurate employment of imaging methods is critical in identifying the most effective treatment approach for CRLM. Different imaging modalities are used to evaluate CRLM, including positron emission tomography (PET)/computed tomography (CT). Among the PET radiotracers, fluoro-18-deoxyglucose (18F-FDG), a glucose analog, is commonly used as the primary radiotracer in assessment of CRLM. As the importance of 18F-FDG-PET/CT continues to grow in assessment of CRLM, developing a comprehensive understanding of this subject becomes imperative for healthcare professionals from diverse disciplines. The primary aim of this article is to offer a simplified and comprehensive explanation of PET/CT in the evaluation of CRLM, with a deliberate effort to minimize the use of technical nuclear medicine terminology. This approach intends to provide various healthcare professionals and researchers with a thorough understanding of the subject matter.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow HK, Duckworth A, Heister P, Praseedom R, Jah A, Balakrishnan A, Harper S, Liau S, Kosmoliaptsis V, Huguet E. Colorectal liver metastases: Current management and future perspectives. World J Clin Oncol 2020; 11:761-808. [PMID: 33200074 PMCID: PMC7643190 DOI: 10.5306/wjco.v11.i10.761] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
The liver is the commonest site of metastatic disease for patients with colorectal cancer, with at least 25% developing colorectal liver metastases (CRLM) during the course of their illness. The management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing chemotherapy, optimisation of liver remnant by portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and combining resection with ablation, in the context of improvements in the functional assessment of the future remnant liver. Liver resection may safely be carried out laparoscopically or open, and synchronously with, or before, colorectal surgery in selected patients. For unresectable patients, treatment options including systemic chemotherapy, targeted biological agents, intra-arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic radiotherapy, and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to operability. Currently evolving areas include biomarker characterisation of tumours, the development of novel systemic agents targeting specific oncogenic pathways, and the potential re-emergence of radical surgical options such as liver transplantation.
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Affiliation(s)
- Jack Martin
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Angelica Petrillo
- Department of Precision Medicine, Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli 80131, Italy, & Medical Oncology Unit, Ospedale del Mare, 80147 Napoli Italy
| | - Elizabeth C Smyth
- Department of Oncology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Nadeem Shaida
- Department of Radiology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom
| | - Samir Khwaja
- Department of Radiology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom
| | - HK Cheow
- Department of Nuclear Medicine, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Adam Duckworth
- Department of Pathology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Paula Heister
- Department of Pathology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Raaj Praseedom
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Asif Jah
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Anita Balakrishnan
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Simon Harper
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Siong Liau
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Emmanuel Huguet
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
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Patil PG, Reddy P, Rawat S, Ananthasivan R, Sinha R. Multimodality Approach in Detection and Characterization of Hepatic Metastases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3402100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AbstractEarly detection of liver metastases is important in patients with known primary malignancies. This plays an important role in treatment planning and impacts on further management of certain primary malignancies.Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography scans are reported to have high accuracy in the diagnosis of intrahepatic lesions. MRI in particular has the advantages of its high tissue sensitivity and its multiparametric approach.Hepatic metastatic lesions have considerable overlap in their radiological appearance, and in this article the imaging appearance of various hepatic metastasis and approach is described.
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Affiliation(s)
- Pooja G. Patil
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rakesh Sinha
- Department of Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
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Kaur H, Hindman NM, Al-Refaie WB, Arif-Tiwari H, Cash BD, Chernyak V, Farrell J, Grajo JR, Horowitz JM, McNamara MM, Noto RB, Qayyum A, Lalani T, Kamel IR. ACR Appropriateness Criteria ® Suspected Liver Metastases. J Am Coll Radiol 2018; 14:S314-S325. [PMID: 28473088 DOI: 10.1016/j.jacr.2017.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Liver metastases are the most common malignant liver tumors. The accurate and early detection and characterization of liver lesions is the key to successful treatment strategies. Increasingly, surgical resection in combination with chemotherapy is effective in significantly improving survival if all metastases are successfully resected. MRI and multiphase CT are the primary imaging modalities in the assessment of liver metastasis, with the relative preference toward multiphase CT or MRI depending upon the clinical setting (ie, surveillance or presurgical planning). The optimization of imaging parameters is a vital factor in the success of either modality. PET/CT, intraoperative ultrasound are used to supplement CT and MRI. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Harmeet Kaur
- Principal Author, University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | - Nicole M Hindman
- Co-author, New York University Medical Center, New York, New York
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Richard B Noto
- Brown University Rhode Island Hospital, Providence, Rhode Island
| | - Aliya Qayyum
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Tasneem Lalani
- Specialty Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kim JM, Kwon CHD, Joh JW, Sinn DH, Choi GS, Paik SW. Prognosis of preoperative positron emission tomography uptake in hepatectomy patients. Ann Surg Treat Res 2018; 94:183-189. [PMID: 29629352 PMCID: PMC5880975 DOI: 10.4174/astr.2018.94.4.183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/06/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Preoperative F-18-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET) imaging results appear to predict tumor recurrence and patient survival. The present study compared outcomes between PET-positive and PET-negative groups with HBV-related hepatocellular carcinoma (HCC) who underwent curative hepatectomy and assessed the prognostic value of positive PET-CT for HCC recurrence and death. Methods This study included patients who underwent liver resection of solitary HCC between 2007 and 2014 based on preoperative radiological images. There were 133 patients in the PET-positive group and 93 in the PET-negative group. Results There were no statistically significant differences in baseline, perioperative, or pathologic characteristics between the 2 groups except HBsAg titer, tumor size, and presence of bile duct tumor thrombi. Multivariate analysis showed that tumor size >3.5 cm and HBsAg titer >1,000 cutoff index were predisposing factors of positive PET-CT. Disease-free survival and overall survival rate at 1, 3, and 5 years were 76.3%, 64.4%, 60.3% and 96.8%, 91.1%, 85.1% in the PET-negative group, respectively, compared with 70.7%, 62.2%, 58.9% and 98.5%, 97.0%, 97.0% in the PET-positive group (P = 0.547 and P = 0.046). Multivariate analysis showed that positive PET-CT was closely associated with increased patient survival, but was not related to HCC recurrence. Conclusion These results suggest that positive PET findings are not a predisposing factor for recurrence of HBV-related HCC patients, but appear to be associated with improved patient survival. Further prospective studies are needed to confirm the prognostic value of 18F-FDG PET in these patients.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
BACKGROUND Imaging plays an important role not only in screening, evaluating, staging, and monitoring disease, but also in surveillance following tumor ablation. Advances in imaging techniques have increased our ability to detect and characterize focal liver lesions, resulting in improvements in diagnostic capability and improved monitoring of liver metastases. This has led to increased interest in both hepatic imaging and image-guided hepatic interventions. METHODS Several imaging options are reviewed according to their effective application, notably computed tomography (CT), CT during arterial portography, ultrasound, magnetic resonance imaging, positron emission tomography, and integrated PET/CT imaging. RESULTS Although there are exceptions regarding imaging options based on patient selection and on institution preference and expertise, multidetector helical CT scanning remains the dominant modality in the evaluation of suspected hepatic metastases, and for preoperative planning, treatment monitoring, and posttreatment follow-up. CONCLUSIONS Ultimately, the choice of imaging modality must be based not only on the patient and the clinical situation, but also on the imaging expertise within each institution.
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Affiliation(s)
- Junsung Choi
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Lee JY, Yoon SM, Kim JT, Kim KB, Kim MJ, Park JG, Lee TG, Lee SJ, Koong SS, Han JH, Chae HB, Park SM, Youn SJ. Diagnostic and prognostic value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography for colorectal cancer: comparison with conventional computed tomography. Intest Res 2017; 15:208-214. [PMID: 28522951 PMCID: PMC5430013 DOI: 10.5217/ir.2017.15.2.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/14/2016] [Accepted: 09/21/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND/AIMS 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been used for preoperative staging of colorectal cancer (CRC). However, the diagnostic accuracy of FDG-PET/CT for detection of lymph node or distant metastasis and its prognostic role have not been well established. We therefore evaluated the diagnostic and prognostic value of FDG-PET/CT in comparison with conventional CT for CRC. METHODS We investigated 220 patients who underwent preoperative FDG-PET/CT and CT, followed by curative surgery for CRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET/CT and CT for detection of lymph node metastasis and distant metastasis were evaluated. In addition, we assessed the findings of FDG-PET/CT and CT according to outcomes, including cancer recurrence and cancer-related death, for evaluation of prognostic value. RESULTS For detection of lymph node metastasis, FDG-PET/CT had a sensitivity of 44%, a specificity of 84%, and an accuracy of 67%, compared with 59%, 65%, and 62%, respectively, for CT (P=0.029, P=0.000, and P=0.022). For distant metastasis, FDG-PET/CT had a sensitivity of 79%, a specificity of 94%, and an accuracy of 93%, compared with 79%, 87%, and 86%, respectively, for CT (P=1.000, P=0.004, and P=0.037). In addition, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were associated significantly with cancer recurrence or cancer-related death (P=0.009, P=0.001, respectively). CONCLUSIONS Preoperative FDG-PET/CT had a higher specificity and accuracy compared to CT for detection of lymph node metastasis and distant metastasis of CRC. In addition, FDG-PET/CT could be a valuable prognostic tool for CRC.
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Affiliation(s)
- Joo Young Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Soon Man Yoon
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jeong Tae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Jin Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae Geun Park
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Jeon Lee
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Soo Koong
- Department of Nuclear Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hee Bok Chae
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seon Mee Park
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sei Jin Youn
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Lee JH, Lee MR. Positron emission tomography/computed tomography in the staging of colon cancer. Ann Coloproctol 2014; 30:23-7. [PMID: 24639967 PMCID: PMC3953165 DOI: 10.3393/ac.2014.30.1.23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 10/12/2013] [Indexed: 12/19/2022] Open
Abstract
Purpose Accurate preoperative staging of colon cancer is essential for providing the optimal treatment strategy and evaluating the expected prognosis. The aim of this study is to assess the value of positron emission tomography/computed tomography (PET/CT) over conventional studies in the staging of colon cancer. Methods A total of 266 colon cancer patients diagnosed between January 2008 and December 2010 were assessed with both PET/CT and conventional studies. Discordance with PET/CT and conventional studies were evaluated, and changes in the management strategy were assessed for each stage. Discordant findings were verified by using intraoperative examination, pathology reports, and follow-up imaging studies. Results Multidetector computed tomography (MDCT) and PET/CT showed similar accuracy in detecting lymph node metastasis in patients with clinical stage III (36.2% vs. 42%, P = 0.822) and stage IV (60.3% vs. 63.5%, P = 0.509) disease. PET/CT led to a change in management strategy for 1 of 40 patients (2.5%) with clinical stage I, 0 of 25 patients (0%) with stage II, 9 of 138 patients (6.5%) with stage III, and 8 of 63 patients (12.7%) with stage IV disease. Conclusion PET/CT changed the management plan in 6.5% of patients with clinical stage III and 12.7% of patients with clinical stage IV colon cancer. Our findings suggest that PET/CT may be considered as a routine staging tool for clinical stage III and IV colon cancers.
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Affiliation(s)
- Jae Hyung Lee
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Tsurusaki M, Okada M, Kuroda H, Matsuki M, Ishii K, Murakami T. Clinical application of 18F-fluorodeoxyglucose positron emission tomography for assessment and evaluation after therapy for malignant hepatic tumor. J Gastroenterol 2014; 49:46-56. [PMID: 23525980 PMCID: PMC3895191 DOI: 10.1007/s00535-013-0790-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/04/2013] [Indexed: 02/04/2023]
Abstract
Positron emission tomography (PET) is widely available and its application with 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors, and monitoring the therapeutic efficacy in hepatic malignancies. Recently, investigators have measured glucose utilization in liver tumors using (18)F-FDG and positron emission tomography/computer tomography (PET/CT) in order to establish a diagnosis of tumors, assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. The PET/CT with (18)F-FDG may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis, staging, restaging and evaluating its biological characteristics, which can benefit the patients suffering from primary and metastatic hepatic tumors such as hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and metastatic liver tumor.
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Affiliation(s)
- Masakatsu Tsurusaki
- Department of Diagnostic Radiology, Kinki University, School of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan,
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Bickenbach KA, Dematteo RP, Fong Y, Peter Kingham T, Allen PJ, Jarnagin WR, D'Angelica MI. Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: a contemporary analysis. Ann Surg Oncol 2012; 20:2029-34. [PMID: 23266582 DOI: 10.1245/s10434-012-2813-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Traditionally, rates of irresectable disease at laparotomy for colorectal liver metastases (CRLM) have ranged from 15 to 70%. Diagnostic laparoscopy has been shown to be effective at preventing nontherapeutic laparotomy in selected patients. The purpose of this study was to analyze the resectability rate and role of diagnostic laparoscopy in a contemporary cohort. METHODS Using a prospectively maintained database, we identified patients who were explored for presumed resectable CRLM. Clinical and pathologic data associated with the finding of irresectable disease were analyzed. RESULTS From 2008-2010, 455 patients were explored. Of these, 35 (7.7%) did not undergo a resection and/or ablation. Of the 35 patients with irresectable disease, 15 (43%) had disease limited to the liver, 17 (49%) had extrahepatic disease (EHD), and 3 (9%) had other reasons precluding resection. Of the whole cohort, 45 patients (9.9%) were found to have EHD, and 27 of these (60%) underwent complete resection or ablation. The only factor associated with irresectable disease was a prior history of EHD, which was present in 29% of those found irresectable versus 13% of those resected (p = 0.022). Diagnostic laparoscopy was performed in 55 patients. Four of these patients had irresectable disease, and three were spared unnecessary laparotomy. Therefore, the yield was 5% and the sensitivity 75%. CONCLUSIONS The finding of irresectable disease is a rare event with modern radiologic assessment and the expansion of indications for resection. Diagnostic laparoscopy has a low yield and should be considered if there is a history of EHD or suspicious findings on preoperative imaging.
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Affiliation(s)
- Kai A Bickenbach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
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Integrating Radioembolization (90Y Microspheres) Into Current Treatment Options for Liver Tumors. Am J Clin Oncol 2012; 35:81-90. [DOI: 10.1097/coc.0b013e3181ec60b8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hellman RS, Krasnow AZ, Sudakoff GS. Positron emission tomography for staging and assessment of tumor response of hepatic malignancies. Semin Intervent Radiol 2011; 23:21-32. [PMID: 21326717 DOI: 10.1055/s-2006-939838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a useful functional imaging method that complements conventional anatomic imaging modalities for screening patients with colorectal hepatic metastases and hepatocellular cancer to determine their suitability for interventional procedures. FDG PET is more sensitive in detecting colorectal cancer than hepatocellular cancer (~90% versus ~50%). The likelihood of detecting hepatic malignancy with FDG PET rapidly diminishes for lesions smaller than 1 cm. The greatest value of FDG PET in these patients is in excluding extrahepatic disease that might lead to early recurrence after interventional therapy. Promising results have been reported with FDG PET that may show residual (local) or recurrent disease before conventional imaging methods in patients receiving interventional therapy. For patients with colorectal hepatic metastases, many investigators believe that patients with PET evidence of recurrent hepatic disease should receive additional treatment even when there is no confirmatory evidence present on other methodologies. For patients with hepatocellular cancer no conclusions regarding the value of FDG PET for assessment of response to interventional therapy can be reached as there is almost no published data.
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Affiliation(s)
- Robert S Hellman
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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O'Connor OJ, McDermott S, Slattery J, Sahani D, Blake MA. The Use of PET-CT in the Assessment of Patients with Colorectal Carcinoma. Int J Surg Oncol 2011; 2011:846512. [PMID: 22312527 PMCID: PMC3263658 DOI: 10.1155/2011/846512] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/13/2011] [Accepted: 04/30/2011] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer is the third most commonly diagnosed cancer, accounting for 53,219 deaths in 2007 and an estimated 146,970 new cases in the USA during 2009. The combination of FDG PET and CT has proven to be of great benefit for the assessment of colorectal cancer. This is most evident in the detection of occult metastases, particularly intra- or extrahepatic sites of disease, that would preclude a curative procedure or in the detection of local recurrence. FDG PET is generally not used for the diagnosis of colorectal cancer although there are circumstances where PET-CT may make the initial diagnosis, particularly with its more widespread use. In addition, precancerous adenomatous polyps can also be detected incidentally on whole-body images performed for other indications; sensitivity increases with increasing polyp size. False-negative FDG PET findings have been reported with mucinous adenocarcinoma, and false-positive findings have been reported due to inflammatory conditions such as diverticulitis, colitis, and postoperative scarring. Therefore, detailed evaluation of the CT component of a PET/CT exam, including assessment of the entire colon, is essential.
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Affiliation(s)
- Owen J. O'Connor
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Shanaugh McDermott
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - James Slattery
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Dushyant Sahani
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael A. Blake
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Wang Y, Liu YF, Cheng Y, Yi DH, Li P, Song WQ, Fu DZ, Wang X. Prognosis of colorectal cancer with liver metastasis: value of a prognostic index. Braz J Med Biol Res 2010; 43:1116-22. [PMID: 20945037 DOI: 10.1590/s0100-879x2010007500103] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 09/16/2010] [Indexed: 01/03/2023] Open
Abstract
The objective of the present study was to explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for the selection of patients who might benefit from hepatic resection for metastatic CRC. A total of 293 patients undergoing liver resection for metastatic CRC (172 males and 80 females ranging in age from 26 to 80 years) were selected and clinical, pathological and outcome data were examined in this retrospective study. The prognostic index (PI) of the patients was calculated on the basis of results of multivariate analysis. Patients were stratified into different groups, with survival curves projected according to PI. The 1-, 3-, and 5-year overall survival rates were 58.3, 26.4, and 11.3%, respectively. Univariate analysis indicated that degree of primary tumor differentiation, resection margin, preoperative carcinoembryonic antigen (CEA) level, number of liver metastases, and resection of liver metastases were associated with prognosis (P < 0.05). In multivariate analysis, the last three factors were found to be independent prognostic factors. The resection of liver metastases was a favorable factor. Patients were classified into three groups according to PI, which differed significantly in survival rate (P < 0.05). The individual survival rate was evaluated based on PI. Resection of hepatic colorectal metastases may produce long-term survival and cure. The proposed PI was easy to use, was highly predictive of patient outcome, and permitted categorization of patients into treatment groups.
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Affiliation(s)
- Y Wang
- Department of General Surgery, The First Hospital of China Medical University, Shen Yang, Liao Ning Province, China
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15
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Wong CYO, Gates VL, Tang B, Campbell J, Qing F, Lewandowski RJ, Thie J, Ho CL, Savin M, Salem R. Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography predicts extrahepatic metastatic potential of colorectal metastasis: a practical guide for yttrium-90 microsphere liver-directed therapy. Cancer Biother Radiopharm 2010; 25:233-6. [PMID: 20423237 DOI: 10.1089/cbr.2009.0735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this retrospective study was to assess the likelihood of extrahepatic metastases based on tumor metabolic load index (TMLI) for patients with colorectal liver metastases to determine the potential intermediate endpoint of yttrium-90 (Y-90) microsphere liver-directed therapy. Forty-eight (48) patients with colorectal metastatic cancer of the liver who were referred for Y-90 microsphere therapy and F-18 fluoro-2-deoxy-D-glucose positron emission tomography (PET) imaging were included. All patients had baseline computed tomography, hepatic angiography, and planning intra-arterial technetium-99m macro-aggregated albumin scans. Pretreatment PET images were analyzed by visual inspection of extrahepatic metastases and by computer quantification of total liver tumor metabolism. For each patient, regions of interest were drawn along the liver edge to measure total liver standard uptake value on axial images, covering the entire span of the liver. The total liver standard uptake value was then converted by logarithm in equivalent volumes of liver mass to obtain TMLI for comparison. A Levene test for equality of variances and t-tests were used for comparing pretreatment TMLIs of patients with or without extrahepatic metastasis. Discriminant and receiver operating characteristic (ROC) analyses were used to obtain a cutoff value with highest specificity in predicting negative extrahepatic metastasis. There were 21 and 27 patients identified as negative and positive for extrahepatic metastasis, respectively. The TMLI of the group with negative extrahepatic metastasis was significantly lower than that with positive extrahepatic metastasis (10.22 + 0.32 versus 10.74 + 0.57, p < 0.0005). The cutoff TMLI with 100% specificity was found to be 10.65. There was a significant difference in liver tumor load with respect to the presence or absence of an extrahepatic metastatic tumor as evaluated objectively with PET. This leads to the identification of TMLI threshold, below which extrahepatic metastases are unlikely and thus may provide guidance for Y-90 therapy.
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Affiliation(s)
- Ching-Yee Oliver Wong
- Department of Nuclear Medicine, Oakland University William Beaumont Hospital, Royal Oak, MI 48073-6769, USA.
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Donati OF, Hany TF, Reiner CS, von Schulthess GK, Marincek B, Seifert B, Weishaupt D. Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med 2010; 51:692-9. [PMID: 20395324 DOI: 10.2967/jnumed.109.068510] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED The purpose of this study was to compare the accuracy of lesion detection and diagnostic confidence between (18)F-FDG PET/CT, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, and retrospectively fused PET and MRI (PET/MRI). METHODS Thirty-seven patients (mean age +/- SD, 60.2 +/- 12 y) with suspected liver metastases underwent PET/CT and Gd-EOB-DTPA-enhanced MRI within 0-30 d (mean, 11.9 +/- 9 d). PET and Gd-EOB-DTPA-enhanced MR image data were retrospectively fused. Images were reviewed independently by 2 readers who identified and characterized liver lesions using PET/CT, Gd-EOB-DTPA-enhanced MRI, and PET/MRI. Each liver lesion was graded on a 5-point confidence scale ranging from definitely benign (grade of 1) to definitely malignant (grade of 5). The accuracy of each technique was determined by receiver-operating-characteristic analysis. Histopathology served as the standard of reference for all patients with malignant lesions. RESULTS A total of 85 liver lesions (55 liver metastases [65%] and 30 benign lesions [35%]) were present in 29 (78%) of the 37 patients. Twenty-four (65%) of the 37 patients had liver metastases. The detection rate of liver lesions was significantly lower for PET/CT than for Gd-EOB-DTPA-enhanced MRI (64% and 85%; P = 0.002). Sensitivity in the detection and characterization of liver metastases for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 was 76%, 91%, 93%, and 93%, respectively; the respective specificity values were 90%, 100%, 87%, and 97%. The difference in sensitivity between PET/CT and PET/MRI was significant (P = 0.023). The level of confidence regarding liver lesions larger than 1 cm in diameter was significantly higher in PET/MRI than in PET/CT (P = 0.046). Accuracy values (area under the receiver-operating-characteristic curve) for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 were 0.85, 0.94, 0.92, and 0.96, respectively. CONCLUSION The sensitivity of Gd-EOB-DTPA-enhanced MRI and PET/MRI in the detection of liver metastases is higher than that of PET/CT. Diagnostic confidence was significantly better with PET/MRI than with PET/CT regarding lesions larger than 1 cm in diameter. Compared with Gd-EOB-DTPA-enhanced MRI, PET/MRI resulted in a nonsignificant increase in sensitivity and diagnostic confidence.
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Affiliation(s)
- Olivio F Donati
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
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Sietses C, Meijerink MR, Meijer S, van den Tol MP. The impact of intraoperative ultrasonography on the surgical treatment of patients with colorectal liver metastases. Surg Endosc 2010; 24:1917-22. [PMID: 20112115 PMCID: PMC2895892 DOI: 10.1007/s00464-009-0874-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 12/19/2009] [Indexed: 12/15/2022]
Abstract
Introduction Intraoperative ultrasonography (IOUS) has been the standard in surgical decision making in oncologic liver surgery. Preoperative imaging techniques have improved substantially in resent years; therefore, the importance of IOUS might change. The current results of IOUS were compared with preoperative high-resolution helical CT scanning and the impact of IOUS on surgical decision making was evaluated. Methods A total of 100 consecutive patients who underwent open surgery for colorectal liver metastases within 4 weeks after preoperative imaging, performed with high-speed helical CT scanners, were included for this study. During surgery, IOUS was performed by a liver specialized radiologist. The findings on preoperative and intraoperative imaging and surgical exploration were compared regarding number, site, and size of the hepatic lesions. The preoperative surgical plan was compared with the final surgical treatment. Results One hundred patients with CRLM underwent 117 surgical treatments. In 38 patients IOUS differed from preoperative data. In 23 cases IOUS identified more metastatic lesions. In five patients, intraoperative findings identified smaller or less hepatic lesions. Additional information on the localization of the hepatic lesions was gathered by IOUS and changed the surgical treatment in ten cases. IOUS alone altered the surgical strategy 35 times during 117 procedures. In nearly all cases, discrepancy between the preoperative CT scan and IOUS resulted in a change of surgical treatment. Conclusions Despite improvement in preoperative imaging technology, the intraoperative use of ultrasonography remains of crucial importance. The detection of preoperatively unknown lesions remains high with great consequence on surgical therapy.
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Affiliation(s)
- C Sietses
- Department of Surgery, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Akiyoshi T, Oya M, Fujimoto Y, Kuroyanagi H, Ueno M, Yamaguchi T, Koyama M, Tanaka H, Matsueda K, Muto T. Comparison of preoperative whole-body positron emission tomography with MDCT in patients with primary colorectal cancer. Colorectal Dis 2009; 11:464-9. [PMID: 18637927 DOI: 10.1111/j.1463-1318.2008.01643.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Preoperative use of emission tomography with(18)F-fluorodeoxyglucose (FDG-PET) in patients with primary colorectal cancer remains controversial. This study evaluated the additional value of FDG-PET in comparison with routine multidetector row computed tomography (MDCT) in patients with primary colorectal cancer. METHOD Retrospective analysis was performed in 65 patients with colorectal cancer who underwent whole-body FDG-PET. Results of FDG-PET were compared with routine preoperative evaluation by MDCT regarding detection of primary tumour, lymph node involvement and distant metastases. All images were evaluated before surgery. RESULTS Tumour detection rate was 100% (63/63) for MDCT and 98% (62/63) for FDG-PET. Lymph node involvement was pathologically confirmed in 35 patients. MDCT and FDG-PET displayed sensitivities of 89% (31/35; 95% CI: 73-97%) and 43% (15/35; 95% CI: 26-61%) and specificities of 52% (11/21; 95% CI: 30-74%) and 95% (20/21; 95% CI: 76-100%), respectively. Liver metastases were present in 22 patients. MDCT and FDG-PET showed accuracies of 98% (64/65; 95% CI: 92-100%) and 97% (63/65; 95% CI: 89-100%), respectively. FDG-PET detected additional extrahepatic metastatic lesions and affected treatment plan compared with MDCT in 10 patients. CONCLUSION Preoperative FDG-PET is not superior to MDCT for detection of primary tumour, lymph node involvement or liver metastases, but may have potential clinical value in patients with advanced colorectal cancer by detecting extrahepatic distant metastases.
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Affiliation(s)
- T Akiyoshi
- Gastroenterological Division, Cancer Institute Hospital, Ariake, Koto-ku, Tokyo, Japan
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Orlacchio A, Schillaci O, Fusco N, Broccoli P, Maurici M, Yamgoue M, Danieli R, D'Urso S, Simonetti G. Role of PET/CT in the detection of liver metastases from colorectal cancer. Radiol Med 2009; 114:571-85. [PMID: 19444590 DOI: 10.1007/s11547-009-0393-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 07/08/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare the diagnostic accuracy of 2-[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) and computed tomography (CT) with PET/CT in the detection of liver metastases during tumour staging in patients suffering from colorectal carcinoma for the purposes of correct surgical planning and follow-up. MATERIALS AND METHODS A total of 467 patients underwent a PET/CT scan using an iodinated contrast medium. We compared images obtained by the single PET scan, the single CT scan and by the fusion of the two procedures (PET/CT). The final diagnosis was obtained by histological examination and/or by the follow-up of all patients, including those who did not undergo surgery or biopsy. RESULTS The PET scan had 94.05% sensitivity, 91.60% specificity and 93.36% accuracy; the CT scan had 91.07% sensitivity, 95.42% specificity and 92.29% accuracy. The combined procedures (PET/CT) had the following values: sensitivity 97.92%, specificity 97.71% and accuracy 97.86%. CONCLUSIONS This study indicates that PET/CT is very useful in staging and restaging patients suffering from colorectal cancer. It was particularly useful when recurrences could not be visualised either clinically or by imaging despite increasing tumour markers, as it guaranteed an earlier diagnosis. PET/CT not only provides high diagnostic performance in terms of sensitivity and specificity, enabling modification of patient treatment, but it is also a unique, high-profile procedure that can produce cost savings.
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Affiliation(s)
- A Orlacchio
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Policlinico Universitario Tor Vergata, Viale Oxford 81, 00133, Roma, Italy.
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Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun 2009; 30:117-25. [DOI: 10.1097/mnm.0b013e32831ec57b] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Inducing resectability of chemotherapy refractory colorectal liver metastasis by radioembolization with yttrium-90 microspheres. Clin Nucl Med 2008; 33:697-9. [PMID: 18806572 DOI: 10.1097/rlu.0b013e318184b9a0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coenegrachts K, De Geeter F, ter Beek L, Walgraeve N, Bipat S, Stoker J, Rigauts H. Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases. Eur Radiol 2008; 19:370-9. [PMID: 18795299 DOI: 10.1007/s00330-008-1163-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/21/2008] [Accepted: 08/23/2008] [Indexed: 12/21/2022]
Abstract
Fluoro-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI), including unenhanced single-shot spin-echo echo planar imaging (SS SE-EPI) and small paramagnetic iron oxide (SPIO) enhancement, were compared prospectively for detecting colorectal liver metastases. Twenty-four consecutive patients suspected for metastases underwent MRI and FDG-PET/CT. Fourteen patients (58%) had previously received chemotherapy, including seven patients whose chemotherapy was still continuing to within 1 month of the PET/CT study. The mean interval between PET/CT and MRI was 10.2+/-5.2 days. Histopathology (n=18) or follow-up imaging (n=6) were used as reference. Seventy-seven metastases were detected. In nine patients, MRI and PET/CT gave concordant results. Sensitivities for unenhanced SS SE-EPI, MRI without SS SE-EPI and FDG-PET/CT were, respectively, 100% (p=9 x 10(-10) vs PET, p=8 x 10(-3) vs MRI without SS SE-EPI), 90% (p=2 x 10(-7) vs PET) and 60%. PET/CT sensitivity dropped significantly with decreasing size, from 100% in lesions larger than 20 mm (identical to MRI), over 54% in lesions between 10 and 20 mm (p=3 x 10(5) versus unenhanced SS SE-EPI), to 32% in lesions under 10 mm (p=6 x 10(-5) versus unenhanced SS SE-EPI). Positive predictive value of PET was 100% (identical to MRI). MRI, particularly unenhanced SS SE-EPI, has good sensitivity and positive predictive value for detecting liver metastases from colorectal carcinoma. Its sensitivity is better than that of FDG-PET/CT, especially for small lesions.
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Wong SKC, Jalaludin BB, Henderson CJA, Morgan MJ, Berthelsen AS, Issac MM, Kneebone A. Direct tumor invasion in colon cancer: correlation with tumor spread and survival. Dis Colon Rectum 2008; 51:1331-8. [PMID: 18551346 DOI: 10.1007/s10350-008-9274-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 01/04/2008] [Accepted: 01/21/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE This study examined the correlation between depth of local invasion in colon cancer and tumor spread and patient survival. METHODS A cohort of 796 patients with a complete set of TNM staging information following an elective resection for colon cancer was selected. The rates of lymph node and distant metastasis, tumor differentiation, and extramural venous invasion for different tumor (T) categories were compared. The effects of initial tumor (T) category on overall patient survival were studied. RESULTS The depth of local tumor invasion correlated strongly with nodal involvement (P = 0.0001), rates of extramural venous invasion (P = 0.0002), poor differentiation (P = 0.0001), and distant metastasis (P = 0.0001). Fifty-seven percent of the patients remained lymph node-negative and distant metastasis-negative irrespective of their depth of tumor invasion had no impact on overall survival (P = 0.49). For patients with lymph node or distant metastasis (43 percent), depth of tumor invasion had significant impact on overall survival (P = 0.001). Thirteen percent of T3N1, 33 percent of T3N2, 40 percent of T4N1, and 68.percent of T4N2 cases had distant metastasis at presentation. CONCLUSION Two types of colon cancer were observed: locally active and tendency to metastasize. For the latter, overall mortality and the risk of metastasis increased with depth of tumor invasion.
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Affiliation(s)
- Siu Kin C Wong
- South Western Sydney Colorectal Tumor Group, Sydney South West Area Health Service, Sydney, Australia.
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Impact of whole-body imaging on treatment decision to radio-frequency ablation in patients with malignant liver tumors: comparison of [18F]fluorodeoxyglucose-PET/computed tomography, PET and computed tomography. Nucl Med Commun 2008; 29:599-606. [PMID: 18528181 DOI: 10.1097/mnm.0b013e3282f8144d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The correct staging of patients with malignant liver tumors before radio-frequency ablation (RFA) is mandatory for successful treatment. Our study aimed to compare the influence on decision to perform RFA of whole-body fluorodeoxyglucose (FDG)-PET/computed tomography (CT) with whole-body contrast-enhanced CT (CE-CT) and PET alone. METHODS Fifty-eight patients with known hepatic malignancies (23, liver metastases 35) received FDG-PET/CT before RFA planned with curative intention. CT and PET data were each read separately, PET/CT fusion data were read in consensus afterward by a third reader group. The diagnostic accuracy of CE-CT, PET alone, and PET/CT to identify patients eligible for RFA was compared and the impact on decision was analyzed. The McNemar test with Bonferroni correction was used to test for significant differences. RESULTS The accuracy and sensitivity to detect correctly intrahepatic and extrahepatic tumor were 94 and 97% for CT, 75 and 54% for PET, and 97 and 95% for PET/CT. The differences between CT and PET, as well as between PET/CT and PET, were statistically significant, but there was no significant difference between PET/CT and CT alone (P>0.65). PET alone, CE-CT, and PET/CT correctly identified 32, 55, and 57 patients, respectively. Again, PET/CT showed no significant advantage over CE-CT. Both imaging methods performed significantly better than PET alone (P<0.0001). Forty-three (74%) of 58 patients underwent RFA with curative intention. CONCLUSION Whole-body imaging changed patient management in 26% of the patients planned for curative intended RFA, yet there was no significant difference between CE-CT and PET/CT.
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Low G, Tho L, Leen E, Wiebe E, Kakumanu S, McDonald A, Poon F. The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer. Surgeon 2008; 6:222-31. [DOI: 10.1016/s1479-666x(08)80032-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rappeport ED, Loft A. Liver metastases from colorectal cancer: imaging with superparamagnetic iron oxide (SPIO)-enhanced MR imaging, computed tomography and positron emission tomography. ACTA ACUST UNITED AC 2008; 32:624-34. [PMID: 17710359 DOI: 10.1007/s00261-007-9297-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The literature about superparamagnetic iron oxide-enhanced MR imaging, computed tomography (CT) and PET (positron emission tomography using fluorine-18 labelled fluoro-deoxy-glucose) in detection of liver metastases (LM) from colorectal cancer is reviewed in this update. Special emphasis is given to studies with surgical standard of reference allowing for the lesion-by-lesion sensitivity to be determined. Based on the review, it is concluded that state-of-the-art anatomical imaging, e.g., SPIO-enhanced MR imaging and multidetector CT (MDCT), must be considered more sensitive than PET in detection of individual LM, due to technical developments in MR imaging, such as liver specific contrast agents, modern sequences and high performance gradients, and in modern MDCT have increased the performance of these modalities. MR imaging with a liver specific contrast agent is recommended for the preoperative evaluation before liver surgery for LM because of high sensitivity and better discrimination between small LM and cysts compared to MDCT. PET or PET/CT can be used for detection of extra-hepatic tumor before liver surgery.
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Affiliation(s)
- Eli D Rappeport
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Dromain C, Leboulleux S, Auperin A, Goere D, Malka D, Lumbroso J, Schumberger M, Sigal R, Elias D. Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. ACTA ACUST UNITED AC 2008; 33:87-93. [PMID: 17632751 DOI: 10.1007/s00261-007-9211-7] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess and compare the performance of CT and 18F-FDG-PET/CT in the evaluation of peritoneal carcinomatosis (PC). METHOD AND MATERIALS Thirty consecutive patients with PC and scheduled for a surgery underwent a CT of the abdomen and pelvis and a whole-body 18F-FDG PET/CT. The extent of PC was assessed precisely using the peritoneal cancer index combining the distribution of tumor throughout 11 abdominopelvic regions with a lesion size score. CT and PET/CT imaging results were compared in all patients with intraoperative findings using an interclass correlation test. RESULTS The presence of PC was correctly determined on CT and PET/CT in 23/28 and 16/28 patients, respectively. The extent of PC was understaged with CT and PET/CT in 27 patients and overstaged with CT and PET/CT in 1 and 2 patients, respectively. The interclass correlation was 0.53 (moderate) between CT and surgery and 0.12 (low) between PET/CT and surgery. The interclass correlation was higher for mucinous tumor (0.63) than for non-mucinous (0.16) on CT imaging whereas no difference was found in PET/CT. CONCLUSION The intraperitoneal assessment of the extent of carcinomatosis, necessary to assess prognosis and treatment planning, is not accurate enough with CT and PET/CT imaging.
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Affiliation(s)
- Clarisse Dromain
- Department of Radiology, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France.
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Wildi SM, Gubler C, Hany T, Petrowsky H, Clavien PA, Jochum W, Gerlach T, Fried M, Mullhaupt B. Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG-PET-CT. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:20-26. [PMID: 17937421 DOI: 10.1002/jcu.20408] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Combined fluorine 18-fluorodeoxyglucose-positron emission tomography-CT imaging has been shown to be of good diagnostic value in the preoperative evaluation of patients with colorectal cancer and liver metastases. The adjunctive use of intraoperative sonography (IOUS) may have a limited impact on treatment selection in these patients. PURPOSE To compare the diagnostic performance of preoperative positron emission tomography (PET)-CT alone and PET-CT combined with IOUS in the evaluation of patients who are considered for curative resection of hepatic metastases from colorectal carcinoma. MATERIALS AND METHODS Patients with colorectal cancer who underwent resection of hepatic metastases and preoperative PET-CT (with or without contrast-enhanced CT) and IOUS were identified. The performance of the imaging techniques was evaluated through review of the radiologic reports, correlation with surgical and histopathologic findings, and clinical follow-up. RESULTS Thirty-one patients (mean age, 63.5 years [range, 53-82 years]) were analyzed. Fifteen patients had received preoperative chemotherapy. The mean interval between PET-CT and IOUS was 22.6 days (range, 1-56 days). In 4 cases, neither PET-CT nor IOUS correctly diagnosed the liver metastases. In all 31 patients, the sensitivity of PET-CT alone and PET-CT combined with IOUS was 63% (95% CI 44-80%) and 93% (95% CI 78-98%), respectively; the positive predictive value was 81% and 89%, respectively. In patients without preoperative chemotherapy (n = 16), the sensitivity of PET-CT alone and PET-CT combined with IOUS was 77% (95% CI 49-94%) and 100% (95% CI 79-100%), respectively. In 11 cases (35%), IOUS altered the surgical strategy. CONCLUSION In patients with colorectal carcinoma and potentially resectable liver metastases on preoperative PET-CT, IOUS can provide additional information that may alter decision making with regard to surgical technique.
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Affiliation(s)
- Stephan M Wildi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zurich, Switzerland
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Haji A. Management of recurrent colorectal cancer with positron emission tomography. Br J Hosp Med (Lond) 2007; 68:580-3. [PMID: 18087843 DOI: 10.12968/hmed.2007.68.11.27678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of positron emission tomography, on its own and in combination with computed tomography, has been integrated into the management algorithm of patients with suspected recurrence of colorectal cancer. This article looks at the biological basis of positron emission tomography, its clinical advantages and disadvantages.
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Margolis DJA, Hoffman JM, Herfkens RJ, Jeffrey RB, Quon A, Gambhir SS. Molecular Imaging Techniques in Body Imaging. Radiology 2007; 245:333-56. [DOI: 10.1148/radiol.2452061117] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nahas CSR, Akhurst T, Yeung H, Leibold T, Riedel E, Markowitz AJ, Minsky BD, Paty PB, Weiser MR, Temple LK, Wong WD, Larson SM, Guillem JG. Positron Emission Tomography Detection of Distant Metastatic or Synchronous Disease in Patients with Locally Advanced Rectal Cancer Receiving Preoperative Chemoradiation. Ann Surg Oncol 2007; 15:704-11. [PMID: 17882490 DOI: 10.1245/s10434-007-9626-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/13/2007] [Accepted: 08/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with locally advanced rectal cancer may present with synchronous distant metastases. Choice of optimal treatment--neoadjuvant chemoradiation versus systemic chemotherapy alone--depends on accurate assessment of distant disease. We prospectively evaluated the ability of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) to detect distant disease in patients with locally advanced rectal cancer who were otherwise eligible for combined modality therapy (CMT). METHODS Ninety-three patients with locally advanced rectal cancer underwent whole-body [18F]FDG PET scanning 2-3 weeks before starting CMT. Sites other than the rectum, mesorectum, or the area along the inferior mesenteric artery were considered distant and were divided into nine groups: neck, lung, mediastinal lymph node (LN), abdomen, liver, colon, pelvis, peripheral LN, and soft tissue. Two nuclear medicine physicians blinded to clinical information used PET images and a five-point scale (0-4) to determine certainty of disease. A score greater than 3 was considered malignant. Confirmation was based on tissue diagnosis, surgical exploration, and subsequent imaging. RESULTS At a median follow-up of 34 months, the overall accuracy, sensitivity, and specificity of PET in detecting distant disease were 93.7%, 77.8%, and 98.7% respectively. Greatest accuracy was demonstrated in detection of liver (accuracy = 99.9%, sensitivity = 100%, specificity = 98.8%) and lung (accuracy = 99.9%, sensitivity = 80%, specificity = 100%) disease; PET detected 11/12 confirmed malignant sites in liver and lung. A total of 10 patients were confirmed to have M1 stage disease. All 10 were correctly staged by pre-CMT PET; abdominopelvic computed tomography (CT) scans accurately detected nine of them. CONCLUSION Baseline PET in patients with locally advanced rectal cancer reliably detects metastatic disease in liver and lung. PET may play a significant role in defining extent of distant disease in selected cases, thus impacting the choice of neoadjuvant therapy.
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Affiliation(s)
- Caio S R Nahas
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Sun L, Wu H, Guan YS. Positron emission tomography/computer tomography: Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies. World J Gastroenterol 2007; 13:2775-83. [PMID: 17569111 PMCID: PMC4395627 DOI: 10.3748/wjg.v13.i20.2775] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Computer tomography (CT) and magnetic resonance imaging (MRI), as conventional imaging modalities, are the preferred methodology for tumor, nodal and systemic metastasis (TNM) staging. However, all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition, relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer, one cannot give an appropriate assessment of the biological characteristics of tumors. Currently, positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors, and monitoring the therapeutic efficacy in hepatic malignancies. Recently, investigators have measured glucose utilization in liver tumors using 18F-FDG, PET and PET/CT in order to establish diagnosis of tumors, assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis, staging, restaging and evaluating its biological characteristics, which can benefit the patients suffering from hepatic metastases, hepatocellular carcinoma and cholangiocarcinoma.
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Affiliation(s)
- Long Sun
- Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen, China
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Abstract
Functional imaging with positron emission tomography (PET) is playing an increasingly important role in the diagnosis and staging of malignant disease, image-guided therapy planning, and treatment monitoring. PET with the labeled glucose analogue fluorine 18 fluorodeoxyglucose (FDG) is a relatively recent addition to the medical technology for imaging of cancer, and FDG PET complements the more conventional anatomic imaging modalities of computed tomography (CT) and magnetic resonance imaging. CT is complementary in the sense that it provides accurate localization of organs and lesions, while PET maps both normal and abnormal tissue function. When combined, the two modalities can help both identify and localize functional abnormalities. Attempts to align CT and PET data sets with fusion software are generally successful in the brain; other areas of the body is more challenging, owing to the increased number of degrees of freedom between the two data sets. These challenges have recently been addressed by the introduction of the combined PET/CT scanner, a hardware-oriented approach to image fusion. With such a device, accurately registered anatomic and functional images can be acquired for each patient in a single scanning session. Currently, over 800 combined PET/CT scanners are installed in medical institutions worldwide, many of them for the diagnosis and staging of malignant disease and increasingly for monitoring of the response to therapy. This review will describe some of the most recent technologic developments in PET/CT instrumentation and the clinical indications for which combined PET/CT has been shown to be more useful than PET and CT performed separately.
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Affiliation(s)
- Todd M Blodgett
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA.
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Klem ML, Grewal RK, Wexler LH, Schöder H, Meyers PA, Wolden SL. PET for staging in rhabdomyosarcoma: an evaluation of PET as an adjunct to current staging tools. J Pediatr Hematol Oncol 2007; 29:9-14. [PMID: 17230060 DOI: 10.1097/mph.0b013e3180307693] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete staging of rhabdomyosarcoma is critical to deliver appropriate therapy. We evaluated the role of F-fluorodeoxyglucose positron emission tomography (PET) in the staging of patients with rhabdomyosarcoma. METHODS Twenty-four patients with rhabdomyosarcoma had a PET scan during staging evaluation, before or within 13 days of initiation of therapy. PET was compared with computed tomography (CT), magnetic resonance imaging (MRI), bone scan, and pathology. RESULTS Ninety-six sites were evaluated. All patients had positive PET scans at the primary site. Thirty-one PET positive sites at primary, regional, or distant sites were biopsied. Pathology in all 31 confirmed disease. Standardized uptake value for the primary site at diagnosis ranged from 2.4 to 12.7 (mean 6.4). At 23 sites, CT or MRI was equivocal for the detection of regional or distant spread. In these cases, a negative PET helped to exclude disease in 21 of 23 patients. PET failed to capture sites of disease visualized by CT, MRI, or bone scan at 10 sites. When comparing PET with the final clinical determination of disease extent, PET was 77% sensitive and 95% specific. CONCLUSIONS These preliminary data indicate that PET is a useful adjunct in staging rhabdomyosarcoma. A prospective study of PET for staging of rhabdomyosarcoma is warranted.
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Affiliation(s)
- Michelle L Klem
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Llamas-Elvira JM, Rodríguez-Fernández A, Gutiérrez-Sáinz J, Gomez-Rio M, Bellon-Guardia M, Ramos-Font C, Rebollo-Aguirre AC, Cabello-García D, Ferrón-Orihuela A. Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging 2006; 34:859-67. [PMID: 17195075 DOI: 10.1007/s00259-006-0274-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 08/25/2006] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In patients with colorectal cancer (CC), 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 One hundred and four patients with a diagnosis of CC (53 males and 51 females; mean age 66.76+/-12.36 years), selected prospectively, were studied for staging using a standard procedure (CT) and FDG-PET. When possible, the reference method was histology. 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 FDG-PET and 87% for CT. FDG-PET results led to modification of the therapy approach in 50% of patients with unresectable disease. FDG-PET findings were important, revealing unknown disease in 19.2%, changing the staging in 13.46% and modifying the scope of surgery in 11.54% (with a change in the therapeutic approach in 17.85% of those patients with rectal cancer). CONCLUSION Compared with conventional techniques, FDG-PET appears to be useful in pre-surgical staging of CC, revealing unsuspected disease and impacting on the treatment approach.
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Gu J, Yamamoto H, Fukunaga H, Danno K, Takemasa I, Ikeda M, Tatsumi M, Sekimoto M, Hatazawa J, Nishimura T, Monden M. Correlation of GLUT-1 overexpression, tumor size, and depth of invasion with 18F-2-fluoro-2-deoxy-D-glucose uptake by positron emission tomography in colorectal cancer. Dig Dis Sci 2006; 51:2198-205. [PMID: 17080242 DOI: 10.1007/s10620-006-9428-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 05/03/2006] [Indexed: 02/04/2023]
Abstract
We investigated the wide variability of 18F-2-fluoro-2-deoxy-D: -glucose (FDG) uptake, semiquantified as standardized uptake value (SUV), in positron emission tomography (PET) scanning, in 20 patients with colorectal cancer (CRC), including 1 with synchronous hepatic metastasis. The sensitivity of PET in CRC diagnosis was 100%, with a mean SUV of 8.0 (3.1-11.9). Tumor size and depth of invasion were associated with higher SUVs (P=.0004, .042, respectively). Strong glucose transporter-1 (GLUT-1) expression had significantly positive correlation with the SUV (r=.619, P=.003). GLUT-1 expression revealed positive staining in 17 (85%) of the 20 primary lesions. The central part of the tumor, thought to be relatively hypoxic, had stronger GLUT-1 expression and a higher SUV than the periphery, in both the primary tumor and hepatic metastatic foci. Our data suggest that the SUVs of FDG uptake in PET may be a noninvasive biomarker for advanced CRC, indicative of a large hypoxic tumor with deep invasion.
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Affiliation(s)
- Jinyu Gu
- Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita-City, Osaka, 565-0871, Japan
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Abstract
[18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) is a useful imaging tool in the evolving management of patients with colorectal carcinoma. This technique is able to measure and visualize metabolic changes in cancer cells. This feature results in the ability to distinguish viable tumor from scar tissue, in the detection of tumor foci at an earlier stage than possible by conventional anatomic imaging and in the measurement of alterations in tumor metabolism, indicative of tumor response to therapy. Nowadays, FDG-PET plays a pivotal role in staging patients before surgical resection of recurrence and metastases, in the localization of recurrence in patients with an unexplained rise in serum carcinoembryonic antigen and in assessment of residual masses after treatment. In the presurgical evaluation, FDG-PET may be best used in conjunction with anatomic imaging in order to combine the benefits of both anatomical (CT) and functional (PET) information, which leads to significant improvements in preoperative liver staging and preoperative judgment on the feasibility of resection. Integration of FDG-PET into the management algorithm of these categories of patients alters and improves therapeutic management, reduces morbidity due to futile surgery, leads to substantial cost savings and probably also to a better patient outcome. FDG-PET also appears to have great potential in monitoring the success of local ablative therapies soon after intervention and in the prediction and evaluation of response to radiotherapy, systemic therapy, and combinations thereof. This review aims to outline the current and future role of FDG-PET in the field of colorectal cancer.
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Affiliation(s)
- Lioe-Fee de Geus-Oei
- Department of Nuclear Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Wong CYO, Savin M, Sherpa KM, Qing F, Campbell J, Gates VL, Lewandowski RJ, Cheng V, Thie J, Fink-Bennett D, Nagle C, Salem R. Regional Yttrium-90 Microsphere Treatment of Surgically Unresectable and Chemotherapy-Refractory Metastatic Liver Carcinoma. Cancer Biother Radiopharm 2006; 21:305-13. [PMID: 16999596 DOI: 10.1089/cbr.2006.21.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this prospective study was to assess the safety and tumor response of intra-arterial Y-90 microspheres for the treatment of surgically unresectable and chemotherapy-refractory liver metastases. MATERIALS AND METHODS Forty-six (46) patients with metastatic cancer to the liver from various solid tumors, with tumor progression despite polychemotherapy, were included. All patients had baseline computed tomography (CT), 18-Fluoro-2-deoxy-D-glucose-positron emission tomography (F-18 FDG-PET), hepatic angiography, and intra-arterial Tc-99m macroaggregated albumin (MAA) scan for the assessment of extrahepatic aberrant perfusion and lung shunting fraction. Twenty-seven (27) and 19 patients were treated with Y-90 glass- or resin-based microspheres (but not both), respectively, on a lobar basis and were monitored over 3 months after last treatment using dedicated attenuation corrected PET. For each patient, regions of interest (ROIs) were drawn along the liver edge to measure total liver standard uptake value (SUV) on axial images covering the entire liver for comparing pre- and post-treatment total liver SUV change. RESULTS There was a significant decrement in total liver SUV after treatment by either glass- or resin-based microspheres (p = 0.0013 and 0.028, respectively). There was no significant difference in the amplitudes of the mean percentage reduction of tumor metabolism between these two agents (20% +/- 25% vs. 10% +/- 30% for glass- vs. resin-based microspheres; p = 0.38). None of the patients in the glass-based group developed complications, whereas 3 patients had complications related to hyperbilirubinemia (1 transient and 2 permanent) in the resin-based group. CONCLUSIONS Results suggest that there is significant mean reduction of hepatic metastatic tumor load (metabolism), as evaluated objectively by PET after Y-90 microsphere, for the treatment of unresectable metastatic disease to the liver. The Y-90 therapy provides encouraging and safe results by arresting the progression of metastatic cancer to the liver with decreasing tumor metabolism.
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Affiliation(s)
- Ching-Yee Oliver Wong
- Positron Diagnostic Center and Medical Cyclotron, Department of Nuclear Medicine, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA.
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Wiering B, Krabbe PFM, Jager GJ, Oyen WJG, Ruers TJM. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer 2006; 104:2658-70. [PMID: 16315241 DOI: 10.1002/cncr.21569] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fluor-18-deoxyglucose-positron emission tomography (FDG-PET) has emerged as a promising diagnostic modality in recurrent colorectal carcinoma. Whole-body FDG-PET may be an accurate diagnostic modality to determine whether patients with recurrent hepatic disease are suitable candidates for curative resection. Reports on the use of FDG-PET in patients with recurrent colorectal carcinoma are scarce, especially those on colorectal liver metastases. To assess the usefulness of this emerging modality for the selection of patients to undergo resection for colorectal liver metastases, a systematic (meta)-analysis of the current literature was conducted. In the absence of randomized controlled clinical trials, a traditional meta-analysis could not be performed. An alternative strategy was designed to evaluate the current literature. After a literature search, an index score was devised to evaluate the articles with regard to the impact of FDG-PET in patients with colorectal liver metastases. The index scored articles on several items and, as such, could be considered an objective approach for the assessment of diagnostic, nonrandomized clinical trials. The proposed index proved to be an independent instrument for judging several research questions and was used systematically to address the sensitivity, specificity, and clinical impact of FDG-PET in patients with colorectal liver metastases. For FDG-PET, the pooled sensitivity and specificity results were 88.0% and 96.1%, respectively, for hepatic disease and 91.5% and 95.4%, respectively, for extrahepatic disease. For the 6 articles that reported the highest scores on the index, the sensitivity and specificity of FDG-PET for hepatic metastatic disease were 79.9% and 92.3%, respectively, and 91.2% and 98.4%, respectively, for extrahepatic disease, respectively. For computed tomography, the pooled sensitivity and specificity results were 82.7% and 84.1%, respectively, for hepatic lesions and 60.9% and 91.1%, respectively, for extrahepatic lesions. The percentage change in clinical management due to FDG-PET was 31.6% (range, 20.0-58.0%) in the articles that scored above the mean and reported this item. For the 6 highest scoring studies, the percentage change in clinical management was 25.0% (range, 20.0-32.0%). Despite apparent omissions in the literature, the combined sensitivity and specificity of FDG-PET clearly indicated that FDG-PET has added value in the diagnostic workup of patients with colorectal liver metastases. FDG-PET can be considered a useful tool in preoperative staging and produced superior results compared with conventional diagnostic modalities, especially for excluding or detecting extrahepatic disease.
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Affiliation(s)
- Bastiaan Wiering
- Department of Surgery, Radboud University Medical Center Nijmegen, The Netherlands.
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Cohen MP, Machado MAC, Herman P. [The impact of intra operative ultrasound in metastases liver surgery]. ARQUIVOS DE GASTROENTEROLOGIA 2006; 42:206-12. [PMID: 16444374 DOI: 10.1590/s0004-28032005000400004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Twenty-five to 50% of the patients with hepatic metastases are potential candidates for curative surgery. Intraoperative ultrasound has been employed to guide the surgery. AIM To evaluate this method in liver surgeries and compare it to other imaging methods. PATIENTS AND METHODS Thirty-five patients (20 females, with median age of 56 years) with hepatic metastases were prospectively studied between February 2001 and July 2003. Patients had as primary tumors: colorectal cancer (24), neuroendocrine tumors (3), renal cell carcinoma (2), melanoma (2), others (4). Each patient was submitted to at least: computed tomography (30), ultrasonography (14) and magnetic resonance imaging (8). Intraoperative ultrasound was performed in all patients in order to detect liver nodules. The number and location of liver lesions were compared to preoperative results. RESULTS Intraoperative ultrasound was useful in 23 (65.6%) of the 35 surgeries and changed the planned surgical strategy in 9 (25.7%). There was a statistical significant correlation between the mean number of nodules identified by ultrasonography, computed tomography, magnetic resonance imaging and intraoperative ultrasound. We found no statistical difference between magnetic resonance imaging and intraoperative ultrasound in identifying hepatic nodules. Fifty-five nodules were submitted to histological evaluation, the gold standard method and 52/55 (94.5%) were identified by intraoperative ultrasound. Intraoperative ultrasound identified 91.6% of the smaller than 1.5 cm lesions, ultrasonography identified 15.0% of them, computed tomography 33.3% and magnetic resonance imaging 66.6%. CONCLUSIONS Intraoperative ultrasound is crucial in the evaluation and decision making in hepatic surgery. Intraoperative ultrasound presents the highest sensibility in the detection of hepatic nodules compared to other imaging methods, especially for small lesions.
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Affiliation(s)
- Marcela Pecora Cohen
- Departamento de Diagnóstico por Imagem, Hospital do Câncer A.C. Camargo, São Paulo, SP.
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41
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Chessin DB, Kiran RP, Akhurst T, Guillem JG. The emerging role of 18F-fluorodeoxyglucose positron emission tomography in the management of primary and recurrent rectal cancer. J Am Coll Surg 2006; 201:948-56. [PMID: 16310700 DOI: 10.1016/j.jamcollsurg.2005.06.277] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 06/15/2005] [Accepted: 06/22/2005] [Indexed: 12/12/2022]
Affiliation(s)
- David B Chessin
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Horst S, Kocak E, Young D, Mantil J, Martin EW. Abdominal positron-emission tomography lesions with increased standardized uptake values correlate with intraoperative findings. Am J Surg 2006; 191:39-44. [PMID: 16399104 DOI: 10.1016/j.amjsurg.2005.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 03/17/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND The reporting of standardized uptake value (SUV) on fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET) in colorectal cancer is becoming common practice, but its clinical utility remains to be determined. This study was designed to compare FDG-PET uptake as measured by SUV with operative findings. METHODS A colorectal cancer database was queried to identify patients who underwent FDG-PET scans with reported SUVs followed by exploratory laparotomy within 3 months and compare these results to determine FDG-PET sensitivity. RESULTS Of 46 patients, 16 (34.8%) were found to be have increased extent of disease intraoperatively than seen on FDG-PET scan. This patient population had a statistically significant decreased mean maximal SUV than the patients whose FDG-PET scan equaled intraoperative findings (P < .025). CONCLUSIONS This initial study indicates patients with potentially resectable disease by PET scan but decreased FDG uptake should undergo laparoscopic evaluation before performing laparotomy.
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Affiliation(s)
- Sara Horst
- Division of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Wong CYO, Qing F, Savin M, Campbell J, Gates VL, Sherpa KM, Lewandowski RJ, Nagle C, Salem R. Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F]fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 2005; 16:1101-6. [PMID: 16105922 DOI: 10.1097/01.rvi.0000168104.32849.07] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the response of hepatic metastases after treatment with intraarterial yttrium 90 radioembolization (ie, use of SIR-Spheres) with use of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS Nineteen patients with metastatic cancer to the liver from various solid tumors with progression despite polychemotherapy were included. All patients underwent baseline computed tomography, FDG PET, hepatic angiography, and intraarterial technetium 99 m macroaggregated albumin scan for assessment of lung shunting fraction. Patients were treated with 90Y resin microspheres on a lobar basis and were monitored for 3 months with use of dedicated attenuation-corrected PET. For each patient, regions of interest were drawn along the liver edge to measure total liver standard uptake value (SUV) on axial images, covering the entire liver. Visual estimates were also performed and graded as +1, 0, -1, -2, or -3 for progression, no change, and mild, moderate, and dramatic improvement by posttreatment PET. RESULTS The median absorbed dose for the tumor was 76 Gy. There was a significant overall decrease in total liver SUV after treatment (baseline, 71,134 +/- 38,055; after SIR-Sphere treatment, 59,941 +/- 26,509; P = .028) for the entire group. Visual estimates placed 15 patients (79%) in response categories (-3 to -1) and four patients (21%) in nonresponse categories (0 to +1) for the liver. The percentage change of total liver SUV after treatment in the response group (-19%) was significantly greater and different in direction than that in the nonresponse group (+27%; P = .03). This percentage change was also correlated significantly with the respective visual estimates (r = 0.72; P < .0005) for each individual patient. Three patients had major complications related to hyperbilirubinemia (transient, n = 1; permanent, n= 2). CONCLUSIONS The results suggest that there is significant reduction of hepatic metastatic load as evaluated objectively by PET after 90Y radioembolization for the treatment of unresectable metastatic disease to the liver. 90Y radioembolization provides encouraging results by arresting progression of metastatic cancer to the liver.
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Affiliation(s)
- Ching-Yee Oliver Wong
- Positron Diagnostic Center and Medical Cyclotron, Department of Nuclear Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073-6769, USA
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Brown G, Daniels IR. Preoperative staging of rectal cancer: the MERCURY research project. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2005; 165:58-74. [PMID: 15865021 DOI: 10.1007/3-540-27449-9_8] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The development of a surgical technique that removes the tumour and all local draining nodes in an intact package, namely total mesorectal excision (TME) surgery, has provided the impetus for a more selective approach to the administration of preoperative therapy. One of the most important factors that governs the success of TME surgery is the relationship of tumour to the circumferential resection margin (CRM). Tumour involves the CRM in up to 20% of patients undergoing TME surgery, and results in both poor survival and local recurrence. It is therefore clear that the importance of the decision regarding the use of pre-operative therapy lies with the relationship of the tumour to the mesorectal fascia. In addition, a high-spatial-resolution MRI technique will identify tumours exhibiting other poor prognostic features, namely, extramural spread >5 mm, extramural venous invasion by tumour, nodal involvement, and peritoneal infiltration. The potential benefits of a selective approach using MRI-based selection criteria are evident. That is, over 50% of patients can be treated successfully with primary surgery alone without significant risk of local recurrence or systemic failure. Of the remainder, potentially dramatic improvements may be achieved through the use of intensive and targeted preoperative therapy aimed not only at reducing the size of the primary tumour and rendering potentially irresectable tumour resectable with tumour-free circumferential margins, but also at enabling patients at high risk of systemic failure to benefit from intensive combined modality therapy aimed at eliminating micrometastatic disease.
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Affiliation(s)
- G Brown
- Department of Radiology, The Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.
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Abstract
Fluorodeoxyglucose PET (FDG-PET) imaging has an important role in determining if there are metastases to the liver and whether disease has spread beyond the liver. Such information is critical for planning surgical resections of liver metastases. The ability of FDG-PET quantitatively to estimate metabolic rates makes it an important tool for monitoring. With increasingly broad indications for FDG-PET imaging, it is expected that FDG-PET (and PET-CT) of the liver will play a growing and increasingly important role in detecting and monitoring treatment of tumors involving the liver.
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Affiliation(s)
- Amir H Khandani
- Section of Nuclear Medicine, Department of Radiology, University of North Carolina, CB 7510, Chapel Hill, NC 27599-7510, USA.
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Kelloff GJ, Hoffman JM, Johnson B, Scher HI, Siegel BA, Cheng EY, Cheson BD, O'shaughnessy J, Guyton KZ, Mankoff DA, Shankar L, Larson SM, Sigman CC, Schilsky RL, Sullivan DC. Progress and promise of FDG-PET imaging for cancer patient management and oncologic drug development. Clin Cancer Res 2005; 11:2785-808. [PMID: 15837727 DOI: 10.1158/1078-0432.ccr-04-2626] [Citation(s) in RCA: 470] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
2-[(18)F]Fluoro-2-deoxyglucose positron emission tomography (FDG-PET) assesses a fundamental property of neoplasia, the Warburg effect. This molecular imaging technique offers a complementary approach to anatomic imaging that is more sensitive and specific in certain cancers. FDG-PET has been widely applied in oncology primarily as a staging and restaging tool that can guide patient care. However, because it accurately detects recurrent or residual disease, FDG-PET also has significant potential for assessing therapy response. In this regard, it can improve patient management by identifying responders early, before tumor size is reduced; nonresponders could discontinue futile therapy. Moreover, a reduction in the FDG-PET signal within days or weeks of initiating therapy (e.g., in lymphoma, non-small cell lung, and esophageal cancer) significantly correlates with prolonged survival and other clinical end points now used in drug approvals. These findings suggest that FDG-PET could facilitate drug development as an early surrogate of clinical benefit. This article reviews the scientific basis of FDG-PET and its development and application as a valuable oncology imaging tool. Its potential to facilitate drug development in seven oncologic settings (lung, lymphoma, breast, prostate, sarcoma, colorectal, and ovary) is addressed. Recommendations include initial validation against approved therapies, retrospective analyses to define the magnitude of change indicative of response, further prospective validation as a surrogate of clinical benefit, and application as a phase II/III trial end point to accelerate evaluation and approval of novel regimens and therapies.
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Affiliation(s)
- Gary J Kelloff
- Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA.
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Bipat S, van Leeuwen MS, Comans EFI, Pijl MEJ, Bossuyt PMM, Zwinderman AH, Stoker J. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis--meta-analysis. Radiology 2005; 237:123-31. [PMID: 16100087 DOI: 10.1148/radiol.2371042060] [Citation(s) in RCA: 364] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To perform a meta-analysis to obtain sensitivity estimates of computed tomography (CT), magnetic resonance (MR) imaging, and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for detection of colorectal liver metastases on per-patient and per-lesion bases. MATERIALS AND METHODS MEDLINE, EMBASE, Web of Science, and CANCERLIT databases and Cochrane Database of Systematic Reviews were searched for relevant original articles published from January 1990 to December 2003. Criteria for inclusion of articles were as follows: Articles were reported in the English, German, or French language; CT, MR imaging, or FDG PET was performed to identify and characterize colorectal liver metastases; histopathologic analysis (surgery, biopsy, or autopsy), intraoperative observation (manual palpatation, intraoperative ultrasonography [US]), and/or follow-up US was the reference standard; and data were sufficient for calculation of true-positive or false-negative values. A random-effects linear regression model was used to obtain sensitivity estimates in assessment of liver metastases. RESULTS Of 165 identified relevant articles, 61 fulfilled all inclusion criteria. Sensitivity estimates on a per-patient basis for nonhelical CT, helical CT, 1.5-T MR imaging, and FDG PET were 60.2%, 64.7%, 75.8%, and 94.6%, respectively; FDG PET was the most accurate modality. On a per-lesion basis, sensitivity estimates for nonhelical CT, helical CT, 1.0-T MR imaging, 1.5-T MR imaging, and FDG PET were 52.3%, 63.8%, 66.1%, 64.4%, and 75.9%, respectively; nonhelical CT had lowest sensitivity. Estimates of gadolinium-enhanced MR imaging and superparamagnetic iron oxide (SPIO)-enhanced MR imaging were significantly better, compared with nonenhanced MR imaging (P = .019 and P < .001, respectively) and with helical CT with 45 g of iodine or less (P = .02 and P < .001, respectively). For lesions of 1 cm or larger, SPIO-enhanced MR imaging was the most accurate modality (P < .001). CONCLUSION FDG PET had significantly higher sensitivity on a per-patient basis, compared with that of the other modalities, but not on a per-lesion basis. Sensitivity estimates for MR imaging with contrast agent were significantly superior to those for helical CT with 45 g of iodine or less.
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Affiliation(s)
- Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Zubeldia JM, Bednarczyk EM, Baker JG, Nabi HA. The Economic Impact of 18FDG Positron Emission Tomography in the Surgical Management of Colorectal Cancer with Hepatic Metastases. Cancer Biother Radiopharm 2005; 20:450-6. [PMID: 16114993 DOI: 10.1089/cbr.2005.20.450] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) is recognized as a powerful tool in the management of patients with recurrent and/or metastatic colorectal cancer. The aim of this was was to analyze costs from the payer's perspective, of adding FDG-PET to a computed tomography (CT) scan preoperatively in colorectal cancer patients with resectable hepatic metastases. METHODS CT with and without FDG-PET were compared among patients with colorectal cancer in staging for surgical resection of hepatic metastases. Outcomes included uncomplicated surgery, complicated surgery, or death. Extrahepatic disease occurrence rates and diagnostic accuracy of CT and FDG-PET were obtained from published sources. Complication rates and costs for CT, FDG-PET, and surgical procedures were obtained from Healthcare Finance Administration data. RESULTS The average expected surgical cost per patient when FDG-PET was used to determine the presence of extrahepatic disease was 16,278 dollars compared to 21,547 dollars for conventional management-a net savings of 5,269 dollars. CONCLUSIONS Integration of FDG-PET into the presurgical evaluation of patients with hepatic metastases could substantially reduce overall costs and patients' morbidity. This substantial net saving results from the unique ability of FDG-PET in excluding patients with extrahepatic disease, and avoiding unnecessary surgical expenses.
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Affiliation(s)
- Jose M Zubeldia
- School of Medicine and Biomedical Sciences, Department of Nuclear Medicine, University at Buffalo, State University of New York, Buffalo, New York 14214-3007, USA
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Khalil HI, Patterson SA, Panicek DM. Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology 2005; 235:872-8. [PMID: 15833992 DOI: 10.1148/radiol.2353041099] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To retrospectively evaluate the prevalence and clinical importance of hepatic lesions considered too small to characterize (TSTC) at initial computed tomography (CT) in women with breast cancer. MATERIALS AND METHODS Approval for this retrospective study was obtained from the institutional review board, which waived the requirement for informed consent. For each woman who received a diagnosis of breast cancer between 1998 and 2002, the authors reviewed the report of the first contrast material-enhanced CT examination that included assessment of the liver. For women with no definite liver metastasis and at least one hepatic lesion considered TSTC, reports of follow-up imaging examinations were reviewed for a change in lesion size; medical records and images were reviewed if there was a change in lesion size. The 95% confidence intervals (CIs) were calculated for best- and worst-case analyses of cases in which different assumptions were used to classify a lesion as benign. RESULTS Of 7692 women, 1012 (13.2%) underwent contrast-enhanced CT including liver assessment. The mean age of the 1012 women was 54.6 years (range, 20.7-89.1 years). The median time from diagnosis of breast cancer to initial CT examination was 14.1 weeks (range, -3.7 to 296 weeks). The presence of at least one hepatic lesion deemed TSTC was reported in 277 of 941 women (29.4%) in whom no definite hepatic metastasis was reported. Subsequent imaging examinations were performed in 191 of the 277 women (69.0%) (median time from initial CT to last follow-up imaging examination, 54 weeks; range, 0.3-302 weeks). Those examinations revealed the lesions were unchanged in 175 (91.6%) women, no longer visible in eight (4.2%), and larger in six (3.1%). In two women (1.0%), change could not be determined. The enlarging hepatic lesions deemed TSTC represented metastatic breast cancer (three patients), metastatic pancreatic cancer (one patient), or cysts (one patient); in one patient, the etiology was not known. Results of best- and worst-case analyses showed that the lesions were benign in 96.9% (95% CI: 93%, 99%) and 92.7% (95% CI: 88%, 96%) of women, respectively. CONCLUSION In 92.7%-96.9% of women with breast cancer and hepatic lesions deemed TSTC but no definite liver metastases at initial CT, the lesions represented a benign finding.
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Affiliation(s)
- Hanan I Khalil
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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Bennett JJ, Cao D, Posner MC. Determinants of unresectability and outcome of patients with occult colorectal hepatic metastases. J Surg Oncol 2005; 92:64-9. [PMID: 16180230 DOI: 10.1002/jso.20341] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients chosen for liver resection of colorectal liver metastases are a select group with minimal disease, favorable tumor biology and earlier presentation when compared to unresectable patients. Despite intense preoperative assessments, operative detection of occult unresectable disease is inevitable for a small group of patients. The aim of this study was to evaluate determinants of occult unresectability, and to establish if patients with occult unresectable disease demonstrate survival benefits similar to resected patients, or more similar to patients diagnosed with metastatic disease who were never explored. METHODS A retrospective medical record review was performed on 171 patients with colorectal hepatic metastases who underwent exploration with the intent of performing a curative liver resection. Patient and tumor characteristics, operative findings and survival were evaluated. Univariate and multivariate analysis were performed to evaluate determinants of unresectability, and survival was determined by Kaplan-Meier analysis. RESULTS One hundred forty-six patients were completely resected and 25 patients were found to have occult unresectable disease during exploration. Of these 25 patients, 10 had more extensive hepatic disease than expected which precluded resection, while 15 patients had unexpected extrahepatic disease. Of the 15 patients with extrahepatic disease, 7 had otherwise resectable liver metastases. Only bilobar disease was a statistically significant finding associated with occult unresectability on multivariate analysis (P = 0.05). Resected patients had a median survival of 37 months, while unresected patients had a median survival of 17 months (P < 0.005). At 3 and 5 years, the overall survival for resected patients was 52% and 29%. The survival at 3 years for patients with occult unresectable disease was only 5%, with no 5 year survivors. CONCLUSIONS The majority of patients with occult unresectable colorectal hepatic metastases had bilobar disease or extrahepatic spread. Despite the process of patient selection that leads to an attempt for curative resection, patients with occult unresectable disease identified at exploration suffer from poor survival that approximates the outcome of patients never considered for resection.
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Affiliation(s)
- Joseph J Bennett
- Department of Surgery, University of Chicago Hospitals, Chicago, Illinois 60637, USA
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