Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer

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.