GASTROINTESTINAL CANCER

Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer

H Furukawa¹, H Ikuma¹, A Seki¹, K Yokoe¹, S Yuen¹, T Aramaki¹, S Yamagushi²

¹ Division of Diagnostic Radiology, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
² Division of Colorectal Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan

Correspondence to:
Dr H Furukawa
Division of Diagnostic Radiology, Shizuoka Cancer Centre Hospital, 1007, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan; h.furukawa{at}scchr.jp

Background: The role of positron emission tomography with the glucose analogue [18F] fluoro-2-deoxy-D-glucose (FDG-PET) in the initial staging of disease in patients with primary colorectal cancer (CRC) has not been adequately assessed.

Aims: To evaluate the additional value of FDG-PET as a staging modality, complementary to routine multidetector row computed tomography (MDCT) in patients with CRC.

Methods: Forty four patients with CRC underwent preoperative MDCT and FDG-PET. The accuracy of intraoperative macroscopic staging was also investigated compared with histopathological diagnosis. All FDG-PET images were evaluated with respect to detectability of the primary tumour, lymph node involvement, and distant metastases. Both MDCT and FDG-PET diagnoses and treatment plan were compared with surgical and histopathological results.

Results: Thirty seven patients underwent surgery. Tumour detection rate was 95% (42/44) for MDCT, 100% (44/44) for FDG-PET, and 100% (37/37) for intraoperative macroscopic diagnosis. Pathological diagnosis of T factor was T1 in five, T2 in four, T3 in 24, and T4 in four cases. Concordance rate with pathological findings of T factor was 57% (21/37) for MDCT and 62% (23/37) for macroscopic diagnosis. Lymph node involvement was pathologically positive in 19 cases. Regarding N factor, overall accuracy was 62% (23/37) for MDCT, 59% (22/37) for FDG-PET, and 70% (26/37) for macroscopic diagnosis. For all 44 patients, FDG-PET findings resulted in treatment changes in only one (2%) patient.

Conclusion: FDG-PET is not superior to routine MDCT in the initial staging of primary CRC.

Abbreviations: PET, positron emission tomography; FDG-PET, [18F] fluoro-2-deoxy-D-glucose-positron emission tomography; CRC, colorectal cancer; CT, computed tomography; MDCT, multidetector row computed tomography

Keywords: positron emission tomography; colorectal surgery; spiral computed tomography; colorectal neoplasms; neoplasm staging

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