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Detection of recurrent and metastatic colorectal cancer: Comparison of positron emission tomography and computed tomography

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Abstract

Background: This study evaluates the clinical value of positron emission tomography (PET) with 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) as compared to computed tomography (CT) in patients with suspected recurrent or metastatic colorectal cancer (CRC).

Methods: A retrospective review of the records of 58 patients who had FDG-PET for evaluation of recurrent or advanced primary CRC was performed. FDG-PET results were compared with those of CT and correlated with operative and histopathologic findings, or with clinical course and autopsy reports.

Results: Recurrent or advanced primary CRC was diagnosed in 40 and 11 patients, respectively. The sensitivity and specificity of FDG-PET were 91% and 100% for detecting local pelvic recurrence, and 95% and 100% for hepatic metastases. These values were superior to CT, which had sensitivity and specificity of 52% and 80% for detecting pelvic recurrence, and 74% and 85% for hepatic metastases. FDG-PET correctly identified pelvic recurrence in 19 of 21 patients; CT was negative in 6 of these patients and equivocal in 4. FDG-PET was superior to CT in detecting multiple hepatic lesions and influenced clinical management in 10 of 23 (43%) patients.

Conclusion: FDG-PET is more sensitive than CT in the clinical assessment of patients with recurrent or metastatic CRC, and provides an accurate means of selecting appropriate treatment for these patients.

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References

  1. Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics 1997.CA Cancer J Clin 1997;47:5–27.

    CAS  PubMed  Google Scholar 

  2. Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer (review).Br J Surg 1996;83:293–304.

    CAS  PubMed  Google Scholar 

  3. Moertel CG, Fleming TR, Macdonald JS, et al. Levamisole and fluorouracil for adjuvant therapy of resected colorectal cancer.N Engl J Med 1990;322:352–8.

    CAS  PubMed  Google Scholar 

  4. Turk PS, Wanebo HJ. Resection of pelvic recurrence. In: Wanebo HJ, ed.Colorectal cancer. St. Louis: CV Mosby, 1993:443–63.

    Google Scholar 

  5. Barr LC, Skene AI, Meirion J, et al. Metastasectomy.Br J Surg 1992;79:1268–74.

    CAS  PubMed  Google Scholar 

  6. Wanebo HJ, Gaker DL, Whitehill R, et al. Pelvic recurrence of rectal cancer. Options for curative resection.Ann Surg 1987;205:482–95.

    CAS  PubMed  Google Scholar 

  7. Tornqvist A, Ekelund G, Leandoer L. The value of intensive follow up after curative resection of colorectal carcinoma.Br J Surg 1982;69:725.

    CAS  PubMed  Google Scholar 

  8. Moertel CG, Fleming TR, Macdonald JS, et al. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patient with resection colon cancer.JAMA 1993;270:943–7.

    Article  CAS  PubMed  Google Scholar 

  9. Adalsteinsson B, Gilmelius B, Graffam S, Hemmingsson A, Pahlman L, Rimsten A. Computed tomography of recurrent rectal carcinoma.Acta Radiol Diag (Stockholm) 1981;22:669–72.

    CAS  Google Scholar 

  10. Moss AA, Theoni RF, Schnyder P, Marguilis AR. Value of computed tomography in the detection and staging of recurrent rectal carcinomas.J Comput Assist Tomogr 1981;5:870–4.

    CAS  PubMed  Google Scholar 

  11. Moss AA. Imaging of colorectal carcinoma.Radiology 1989;170:308–10.

    CAS  PubMed  Google Scholar 

  12. Nieweg OE. Potential applications of positron emission tomography in surgical oncology.Eur J Surg Oncol 1994;20:415–24.

    CAS  PubMed  Google Scholar 

  13. Schlag P, Lehner B, Strauss LG, Georgi P, Herfarth C. Scar or recurrent rectal cancer. Positron emission tomography is more helpful for diagnosis than immunoscintigraphy.Arch Surg 1989;124:197–200.

    CAS  PubMed  Google Scholar 

  14. Strauss LG, Clorius JH, Schlag P, et al. Recurrence of colorectal tumours: FDG-PET evaluation.Radiology 1989;170:329–32.

    CAS  PubMed  Google Scholar 

  15. Beets G, Penninckx F, Scheipers C, et al. Clinical value of whole body positron emission tomography with FDG in recurrent colorectal cancer.Br J Surg 1994;81:1666–70.

    CAS  PubMed  Google Scholar 

  16. Scheipers C, Penninckx F, De Vadder N, et al. Contribution of PET in the diagnosis of recurrent colorectal cancer: comparison with conventional imaging.Eur J Surg Oncol 1995;21:517–22.

    Google Scholar 

  17. Philpott GW, Schwarz SW, Anderson CJ, et al. RadioimmunoPET: detection of colorectal carcinoma with positron-emitting copper-64-labelled monoclonal antibody.J Nucl Med 1995;36:1818–24.

    CAS  PubMed  Google Scholar 

  18. Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following curative surgery for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy.Cancer 1974;34:1278–92.

    CAS  PubMed  Google Scholar 

  19. Olson RM, Perencevich NP, Malcolm AW, et al. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum.Cancer 1980;45:2969.

    CAS  PubMed  Google Scholar 

  20. Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effects of early detection and aggressive surgery.Br J Surg 1986;73:342–4.

    CAS  PubMed  Google Scholar 

  21. Turk PS, Wanebo HJ. Results of treatment of nonhepatic recurrence of colorectal carcinoma.Cancer 1993;71:4267–77.

    CAS  PubMed  Google Scholar 

  22. Greenway B. Hepatic metastases from colorectal cancer: resection or not?Br J Surg 1988;75:511–9.

    Google Scholar 

  23. Sugarbaker PH. Surgical decision making for large bowel cancer metastatic to the liver.Radiology 1990;174:621–6.

    CAS  PubMed  Google Scholar 

  24. Wagner JS, Adson MA, Van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment.Ann Surg 1984;199:502–8.

    CAS  PubMed  Google Scholar 

  25. Sugarbaker PH, Kemeny N. Management of metastatic liver cancer.Adv Surg 1984;22:1–55.

    Google Scholar 

  26. Sugarbaker PH. Peritonectomy procedures.Ann Surg 1995;221:29–42.

    CAS  PubMed  Google Scholar 

  27. Willett CG, Shellito PC, Tepper JE, et al. Intra-operative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma.Cancer 1991;67:1504–8.

    CAS  PubMed  Google Scholar 

  28. Allen-Mersh TG, Earlam S, Fordy C, Abrahms K, Houghton J. Quality of life and survival with continuous hepatic artery floxuridine infusion for colorectal liver metastases.Lancet 1994;344:1255–60.

    CAS  PubMed  Google Scholar 

  29. Vaughn DJ, Haller DG. Nonsurgical management of recurrent colorectal cancer.Cancer 1993;71:4278–92.

    CAS  PubMed  Google Scholar 

  30. Thompson WM, Trenkner SW. Staging of colorectal carcinoma.Radiol Clin North Am 1994;32:25–37.

    PubMed  Google Scholar 

  31. Butch RJ, Stark DD, Wittenberg J, et al. Staging rectal cancer by MR and CT.AJR 1986;146:1155–60.

    CAS  PubMed  Google Scholar 

  32. Chan TW, Kressel HY, Milestone B, et al. Rectal carcinoma: staging at MR imaging with endorectal surface coil.Radiology 1991;181:461–7.

    CAS  PubMed  Google Scholar 

  33. Beynon J, Mortensen NJMcC, Foy DMA, et al. The detection and evaluation of locally recurrent rectal cancer with rectal ultrasonography.Dis Colon Rectum 1989;32:509–17.

    CAS  PubMed  Google Scholar 

  34. Kubota K, Kubota R, Yamada Y. FDG accumulation in tumour tissue (Editorial).J Nucl Med 1993;34:419–21.

    CAS  PubMed  Google Scholar 

  35. Engenhart R, Kimmig BN, Strauss LG, et al. Therapy monitoring of presacral recurrences after high dose irradiation: value of PET, CT, CEA and pain score.Strahlentherapie Onkologie 1992;168:203–12.

    CAS  Google Scholar 

  36. Conti PS, Lilien DL, Hawley K, Keppler J, Grafton ST, Balding JR. PET and [18F]-FDG in oncology: a clinical update.Nucl Med Biol 1996;23:717–35.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA

    Fidelma L. Flanagan MD, Farrokh Dehdashti MD, Barry A. Siegel MD & Diane D. Trask CNMT

  2. Section of Colon and Rectal Surgery, Dept. of Surgery, Washington University School of Medicine, 216 South Kingshighway Blvd., 63110, St. Louis, MO, USA

    Olagunju A. Ogunbiyi MD, FRCS, Elisa H. Birnbaum MD, James W. Fleshman MD, Thomas E. Read MD, Gordon W. Philpott MD &  Ira J. Kodner MD

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  1. Olagunju A. Ogunbiyi MD, FRCS
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  2. Fidelma L. Flanagan MD
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  3. Farrokh Dehdashti MD
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  4. Barry A. Siegel MD
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  5. Diane D. Trask CNMT
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  6. Elisa H. Birnbaum MD
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  7. James W. Fleshman MD
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  8. Thomas E. Read MD
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  9. Gordon W. Philpott MD
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  10. Ira J. Kodner MD
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Ogunbiyi, O.A., Flanagan, F.L., Dehdashti, F. et al. Detection of recurrent and metastatic colorectal cancer: Comparison of positron emission tomography and computed tomography. Annals of Surgical Oncology 4, 613–620 (1997). https://doi.org/10.1007/BF02303744

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  • DOI: https://doi.org/10.1007/BF02303744

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