Incidental anal 18fluorodeoxyglucose uptake: Should we further examine the patient?

Table 1 Characteristics of the global population (n = 134)

Variables	Global population	Patients non investigated	Patients investigated	P value
	n (%) or mean ± SD	n (%) or mean ± SD	n (%) or mean ± SD
	n = 134	n = 86	n = 48
Age (yr)	61.3 (12.8)	61.0 (12.1)	61.9 (14.1)	0.69
Gender (male)	84 (62.7)	56 (65.1)	28 (58.3)	0.43
18FDG PET/CT indications				0.42
Diagnosis	20 (14.9)	10 (11.6)	10 (20.8)
Follow-up of a known cancer	47 (35.1)	32 (37.2)	15 (31.3)
Staging of a known cancer	45 (33.6)	32 (37.2)	13 (27.1)
Suspicion of cancer recurrence	17 (12.7)	9 (10.5)	8 (16.7)
Diagnosis of infectious/inflammatory disease	5 (3.7)	3 (3.5)	2 (4.2)
Primitive cancer				0.13
Hematological cancer	22 (16.4)	17 (20.0)	5 (10.5)
Head and neck cancer	14 (10.4)	9 (10.5)	5 (10.4)
Lung cancer	25 (18.6)	21 (24.4)	4 (8.3)
Gynecological cancer	22 (16.4)	13 (15.1)	9 (18.8)
Urological cancer	4 (3.0)	1 (1.1)	3 (6.3)
Digestive cancer	14 (10.5)	8 (3.5)	6 (12.5)
Melanoma	9 (6.7)	5 (5.8)	4 (8.3)
Others1	7 (5.2)	3 (3.5)	4 (8.3)
Past history of pelvic radiotherapy2	13 (9.7)	8 (9.3)	5 (10.4)	0.83
Past history of proctologic diseaseb	21 (15.7)	6 (7.0)	15 (31.3)	0.0002
18FDG PET/CT
SUV mean	5.5 (2.3)	5.3 (2.1)	5.9 (2.6)	0.15
SUV max	9.6 (3.9)	9.2 (3.5)	10.2 (4.5)	0.13
MV50 (cm3)	4.1 (2.8)	4.2 (3.0)	4.0 (2.3)	0.65
MV41 (cm3)	6.6 (4.2)	6.7 (4.6)	6.4 (3.5)	0.64
MV 30 (cm3)	11.9 (7.1)	12.2 (7.7)	11.4 (5.9)	0.51

^bP < 0.01.

¹Others: sarcoma, neuroendocrine carcinoma, neurological cancer, carcinoma unknown primary syndrome.

²> 3 mo before fluorodeoxyglucose positron emission tomography with computed tomography.

¹⁸F-FDG PET/CT: Fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography; SUV: Maximum standardized uptake value; MV: Metabolic volume.

Table 2 Characteristics of population investigated (n = 48)

	All	No treatment offered	Treatment offered	P value
	n (%) or mean ± SD	n (%) or mean ± SD	n (%) or mean ± SD
	n = 48	n = 30	n = 18
Assessmenta by				0.0457
Proctologist	30 (62.5)	15 (50.0)	15 (83.3)
Gastroenterologist	10 (20.8)	7 (23.3)	3 (16.7)
Oncologist	2 (4.2)	2 (6.7)
Radiotherapist	5 (10.4)	5 (16.7)
Surgeon	1 (2.1)	1 (3.3)
Examination
Anal margin	46 (95.8)	29 (96.7)	17 (94.4)	0.71
Rectal digital examination	40 (85.2)	25 (86.2)	15 (83.3)	0.78
Anoscopy	24 (51.1)	12 (41.4)	12 (66.7)	0.09
Colonoscopy	17 (36.2)	11 (38.0)	6 (33.3)	0.75
Examination under general anesthesiaa	5 (10.6)	1 (3.5)	4 (22.2)	0.04
Biopsies	8 (17.0)	3 (10.3)	5 (27.8)	0.12
Endoanal ultrasound	7 (14.9)	5 (17.2)	2 (11.1)	0.56
Pelvic MRI	2 (4.3)	1 (3.5)	1 (5.6)	0.73
Symptom	19 (40.4)	9 (31.0)	10 (58.8)	0.06
18FDG PET/CT
SUV meana	5.9 (2.6)	5.2 (1.9)	7.2 (3.2)	0.02
SUV maxa	10.2 (4.5)	9.0 (3.3)	12.4 (5.4)	0.02
MV50	4.0 (2.3)	4.4 (2.4)	3.3 (2.0)	0.13
MV41	6.4 (3.5)	7.2 (3.6)	5.1 (3.0)	0.05
MV 30a	11.4 (6.0)	12.9 (6.3)	8.9 (4.4)	0.03
Diagnosis of a proctological diseaseb	33 (68.8)	15 (50.0)	18 (100.0)	0.003
Haemorrhoidal disease	19	2	12
Anal fissure	6	1	5
Recurrence of rectal adenocarcinoma	2	0	2
Condyloma	3	1	2
Fecal impaction	1	1	0
Anal suppuration	1	0	1
Solitary rectal ulcer syndrome	1	0	1
Treatment	18 (37.5)		18 (100)
Medical treatment			11 (61.1)
Surgical treatment			5 (27.8)
Medical and instrumental treatments			1 (5.6)
Endoscopic treatment			1 (5.6)

^aP < 0.05;

^bP < 0.01. MRI: Magnetic resonance imaging;

¹⁸F-FDG PET/CT: Fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography; SUV: Maximum standardized uptake value; MV: metabolic volume.

Table 3 Treatments

	n (%)
Total	18 (100)
Medical treatment	11 (61.1)
Transit regulator	4 (22.2)
Oral analgesic treatment	1 (5.6)
Topical treatment	8 (44.4)
Treatment of hemorrhoids	4 (22.2)
5-aminosalicylic acid	1 (5.6)
Antibiotic (metronidazole)	1 (5.6)
Botulinum toxin injection	1 (5.6)
Healing cream	1 (5.6)
Surgical treatment	5 (27.9)
Electrocoagulation of condyloma	1 (5.6)
Surgery of hemorrhoids	2 (11.1)
Fissurectomy	1 (5.6)
Posterior pelvectomy	1 (5.6)
Instrumental and medical treatment
Infrared coagulation and imiquimod	1 (5.6)
Endoscopic treatment
Hydraulic dilatation	1 (5.6)