The role of FDG-PET/CT in the detection of recurrent colorectal cancer |
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Authors: | Jana Votrubova Otakar Belohlavek Monika Jaruskova Martin Oliverius Radka Lohynska Kristina Trskova Eva Sedlackova Ludmila Lipska Vladimira Stahalova |
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Institution: | (1) PET Centre, Na Homolce Hospital, Roentgenova 5, 150 30 Prague, Czech Republic;(2) Institute of Clinical and Experimental Medicine, Prague, Czech Republic;(3) Department of Radiotherapy and Oncology, University Hospital Motol, Prague, Czech Republic;(4) Department of Oncology, Na Homolce Hospital, Prague, Czech Republic;(5) Department of Oncology, General Teaching Hospital and 1st Faculty of Medicine, Prague, Czech Republic;(6) Department of Surgery, Thomayer’s Teaching Hospital and 1st Faculty of Medicine, Prague, Czech Republic;(7) Institute of Radiation Oncology, Na Bulovce Teaching Hospital, Prague, Czech Republic |
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Abstract: | Purpose The conventional diagnostic techniques used to assess recurrence of colorectal cancer (CRCR) often yield unspecific findings.
Integrated FDG-PET/CT seems to offer promise for the differential diagnosis of benign and malignant lesions. The aim of this
study was to compare the value of FDG-PET and PET/CT in the detection of CRCR subsequent to colonic resection or rectal amputation.
Methods The population for this retrospective study comprised 84 patients with suspected CRCR. The sensitivity, specificity and accuracy
of PET and PET/CT were calculated for (a) intra-abdominal extrahepatic recurrences, (b) extra-abdominal and/or hepatic recurrences
and (c) all recurrences, and tumour marker levels were analysed.
Results The sensitivity, specificity and overall accuracy of PET in detecting intra-abdominal extrahepatic CRCR were 82%, 88% and
86%, respectively, compared with 88%, 94% and 92%, respectively, for PET/CT. The corresponding figures for detection of extra-abdominal
and/or hepatic CRCR were 74%, 88% and 85% for PET and 95%, 100% and 99% for PET/CT. Considering the entire population, the
sensitivity, specificity and overall accuracy of PET were 80%, 69% and 75%, respectively, compared with 89%, 92% and 90%,
respectively, for PET/CT. FDG-PET/CT examination correctly detected 40 out of a total of 45 patients with CRCR. Two of five
patients with falsely negative FDG-PET/CT findings had local microscopic recurrences and one had miliary liver metastases.
Of 39 patients without CRCR, three showed false positive FDG-PET/CT results. Two of these cases were due to increased accumulation
in inflammatory foci in the bowel wall, while one was due to haemorrhaging into the adrenal gland.
Conclusion FDG-PET/CT appears to be a very promising method for distinguishing a viable tumour from fibrous changes, thereby avoiding
unnecessary laparotomy. |
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Keywords: | FDG-PET/CT Colorectal cancer Recurrence Restaging Tumour markers |
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