PET scanning is not superior to whole-body multi-detector helical computed tomography in the preoperative staging of colorectal cancer

Hiroyoshi Furukawa ^1*, Hiroki Ikuma ¹, Akihiko Seki ¹, Takeshi Aramaki ¹, Sachiko Yuen ¹, Koiku Yokoe ¹ and Shigeki Yamaguchi ¹

¹ Shizuoka Cancer Center Hospital, Japan

^* To whom correspondence should be addressed. E-mail: h.furukawa{at}scchr.jp.

Accepted 7 December 2005

Abstract

Background: The role of positron emission tomography with glucose analog [18F] fluoro-2-deoxy-D- glucose (FDG-PET) in the initial staging of disease in patients with primary colorectal carcinoma (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 investigated and 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 plans were compared against followed surgical and histopathological results.

Results: Thirty-seven patients underwent surgery. The tumour detection rate was 95% (42/44) in MDCT, 100% (44/44) in FDG-PET, and 100% (37/37) in intraoperative macroscopic diagnosis. Pathological diagnosis of T factor was T1 in 5, T2 in 4, T3 in 24, and T4 in 4. The concordance rate with the pathologic findings of T factor was 57% (21/37) in MDCT and 62% (23/37) in macroscopic diagnosis. Lymph node involvement was pathologically positive in 19 cases. Regarding N factor, the overall accuracy was 62% (23/37) in MDCT, 59% (22/37) in FDG-PET, and 70% (26/37) in macroscopic diagnosis. Of 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.

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

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