back to 2012, vol. 18, b. 1
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski>, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2012, vol. 18, book 1
Subject Collection: Medicine
Page: 250-256
DOI: 10.5272/jimab.2012181.250
Published online: 29 June 2012

J of IMAB 2012; 18(1):250-256
Nikola Y. Kolev, Anton Y. Tonev, Valentin L. Ignatov, Georgi H. Ivanov, Aleksander K. Zlatarov, Georgi Todorov, Krasimir D. Ivanov
1st Clinic of Surgery, University Hospital “St. Marina”, Varna, Medical University of Varna, Bulgaria.

INTRODUCTION: In patients with colorectal cancer (CRC), 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: In First Clinic of Surgery at University Hospital “St. Marina” one hundred and four patients with a diagnosis of CRC (53 males and 51 females; mean age 66.76± 12.36 years), selected prospectively. All patients were studied for staging using a standard procedure (CT) and FDG-PET. The reference method was histology. The effect of FDG-PET on the diagnose and the operative treatment was studied.
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 FDGPET and 87% for CT. FDG-PET results led to modification of the therapy approach in 17.85% of the patients with rectal cancer and in 14.8% of the patients with colon cancer.
CONCLUSION: Compared with conventional techniques, FDGPET appears to be useful in pre-surgical staging of CC, revealing unsuspected disease and impacting on the treatment approach.

Key words: 18F-FDG, Position emission tomography, Colorectal cancer, Staging.

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Please cite this article as: Kolev NY, Tonev AY, Ignatov VL, Ivanov GH, Zlatarov AK, Todorov G, Ivanov KD. INFLUENCE OF THE FDG-PET/CT ON THE DIAGNOSE AND STAGING OF COLORECTAL CANCER. J of IMAB. 2012; 18(1):250-256; doi: 10.5272/jimab.2012181.250

1. Abdel Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantowicz PJ, Carbone GM, et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology. 1998; 206:755–60.
2. Skibber JM, Minsky BD, Hoff PM. Cancer of the colon. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer. Principles and practice of oncology. Philadelphia: Lippincott, Williams &Wilkins; 2001; p. 1216–71.
3. Cohen AM. Preoperative evaluation of patients with primary colon cancer. Cancer. 1992;70:1328–72.
4. Bleeker WA, Mulder NH, Hermans J, Otter R, Plukker JT. Valueand cost of follow-up after adjuvant treatment of patients withDukes’ C colonic cancer. Br J Surg. 2001; 88:101–6.
5. Geoghegans JG, Scheele J. Treatment of colorectal liver metastases. Br J Surg 1999; 86:158–69.
6. Brown G, Husband JE, Cook G. Colorectal cancer. In: Husband JE, Reznek RH, editors. Imaging in oncology. London: Taylor & Francis; 2004; p. 217–43.
7. Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, et al. Five-year survival following hepatic resection alter neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol. 2001; 8:347–53.
8. Clavien PA, Selzner N, Morse M, Selzner M, Paulson E. Downstaging of hepatocellular carcinoma and liver metastases 866 Eur J Nucl Med Mol Imaging (2007) 34:859–867 from colorectal cancer by selective intra-arterial chemotherapy. Surgery 2002; 131:433–42.
9. Cook GJR. Artifacts and normal variants in whole-body PET imaging. In: Valk PE, Bailey DL, Townsend DW, Maisey MN, editors. Positron emission tomography. Basic science and clinical practice. London: Springer; 2003; p. 495–505.
10. Cabrera Villegas A, Gamez Cenzano C, Martin Urreta JC. Tomografía por emisión de positrones (PET) en oncología clínica. Rev Esp Med Nuclear 2002;2:131–47.
11. Rodríguez Fernández A, Gómez Río M, Llamas-Elvira JM, Ortega-Lozano S, Ferron-Orihuela JA, Ramia-Angel JM, et al. Positronemission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis. Am J Surg 2004;188:171–5.
12. Tanaka T, Kawai Y, Kanai M, Taki Y, Nakamoto Y, Takabayashi A. Usefulness of FDG-positron emission tomography in diagnosing peritoneal recurrence of colorectal cancer. Am J Surg 2002;184:433–6.
13. Kinkel K, Lu Y, Both M, Warren RS, Thoeni R. Detection of hepatic metastases from cancers of the gastrointestinal tract by using non-invasive imaging methods (US, CT, MR Imaging, PET): a meta-analysis. Radiology 2002;224:748–56.
14. Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 2000; 41:1177–89.
15. Abdel Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantowicz PJ, Carbone GM, et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998;206:755–60.
16. Mukai M, Sadahiro S, Yasuda S, Ishida H, Tokunaga N, Tajima T, et al. Preoperative evaluation by whole-body 18F-fluorodeoxyglucose positron emission tomography in patients with primary colorectal cancer. Oncol Rep 2000;7:85–7.
17. Kantorova I, Lipska L, Belohlavek O, Visokai V, Trubac M,Schneiderova M. Routine 18F-FDG-PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. J Nucl Med 2003;44:1784– 8.
18. Debois JM. TxNxM1: The anatomy and clinics of metastastic cancer. Part II: The primary and its metastases. Boston: Kluwer Academic; 2002; p. 366–97.
19. Bipat S, van Leeuwen MS, Comans EFI, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging and PET for diagnosis—meta-analysis. Radiology 2005;237:123–31.
20. American Joint Committee on Cancer. AJCC Cancer Staging Manual, 6th edition. Berlin Heidelberg, New York: SPringer; 2002; p.113–23.
21. Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging- a meta-analysis. Radiology 2004; 232:773–83.
22. Delbeke D, Martin WH. PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med 2004; 34:209–33.
23. Carrington BM. Lymph node metastases. In: Husband JES, Reznek RH, editors. Imaging in oncology. London: Taylor & Francis; 2004; p. 999–1022.
24. Bjelovic M, Kalezic V, Petrovic M, Pesko P, Usaj SK, Marinkovic J, et al. Correlation of macroscopic and histological characteristics in the regional lymph nodes of patients with rectal and sigmoidal adenocarcinoma. Hepatogastroenterology 1998;45:433–8.
25. Beets-Tan RGH, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology 2004; 232:335-46.
26. Vitola JV, Delbeke D, Sandler MP, Campbell MG, Powers TA, Wright JK, et al. Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver. Am J Surg 1996;171:21–6.
27. Boykin KN, Zibari GB, Lilien DL, McMillan RW, Aultman DF, McDonald JC. The use of FDG-positron emission tomography for the evaluation of colorectal metastases to the liver. Am Surg 1999;65:1183–5.
28. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004; 231:305–32.
29. Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001; 233:293–9.
30. Rohren EM, Paulson EK, Hagge R, Wong TZ, Killius J, Clavien PA, et al. The role of 18F-FDG PET in preoperative assessment of the liver in patients being considered for curative resection of hepatic metastases from colorectal cancer. Clin Nucl Med 2002; 27:550–556

Accepted for publication: 18 November 2011
Issue published online: 29 June 2012

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