Clinical Relevance of Incidental Finding of Focal Uptakes in the Colon during 18F-FDG PET/CT Studies in Oncology Patients without Known Colorectal Carcinoma and Evaluation of the Impact on Management

Andía, G. Salazar; Soriano, A. Prieto; Candil, A. Ortega; Martín, María Nieves Cabrera; Roiz, C; Zapata, Jaime; Arboniés, J. Cardona; Gutiérrez, L. Lapeña; Delgado, José Luis Carreras

doi:10.1016/j.remngl.2011.03.012

Cited by 16 publications

(14 citation statements)

References 26 publications

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“…Similar results were seen in a few recent studies where 44%, 56%, and 64% of the colonic pathologies detected on FDG PET were premalignant or malignant lesions. [171819] These findings concur with most of the studies in literature, thus emphasizing the need to confirm focal colonic FDG uptake with colonoscopy. In one patient (pt # 18), focal uptake (SUV ma × 11.3) in the sigmoid colon was diagnosed as inflammatory after colonoscopy.…”

Section: Discussionsupporting

confidence: 88%

“…There have been several reports and studies that have investigated the clinical relevance of incidental focal uptake of FDG localized specifically to the colon–rectum. [141516171819] Though our study is on similar lines, the epidemiological profile of our patients as regards colorectal lesions was different from other patient populations, particularly their Western counterparts. [2021]…”

Section: Discussionmentioning

confidence: 67%

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Etiology and significance of incidentally detected focal colonic uptake on FDG PET/CT

Purandare

Gawade

Puranik

et al. 2012

Indian J Radiol Imaging

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Background:Incidental colonic uptake of 18F-flurodeoxyglucose (FDG) is not an infrequent finding encountered during whole body positron emission tomography (PET) imaging. Almost all studies on this topic are in Western populations, which have a markedly different epidemiological profile for colorectal premalignant and malignant conditions as compared to that of the Indian subcontinent.Aim:The purpose of this study was to assess the etiology of incidentally detected focal FDG uptake in the colon by comparing it with colonoscopy and histopathology.Materials and Methods:Electronic medical records of patients who underwent FDG PET/computed tomography (CT) at our institution for a 2½-year period from January 2009 to July 2011 were reviewed. There were 32 out of 9000 (0.35%) patients whose PET/CT reports mentioned incidental focal colonic FDG uptake, of which 24 patients subsequently underwent colonoscopy. Lesions which appeared neoplastic on colonoscopy were confirmed with histopathology obtained after biopsy or surgery. Colonoscopy and pathology findings were considered as gold standard.Results:Among the 24 patients who underwent a colonoscopy, 3 patients had normal findings (12.5%). A positive colonoscopy was noted in 21 patients (87.5%) with the lesion coinciding with the location described in the PET/CT report. Adenomatous polyps were detected in 12 patients (37.5%), whereas in 8 patients (25%) malignant lesions were confirmed [adenocarcinoma n = 5, non-Hodgkin's lymphoma (NHL) n = 2, malignant melanoma n = 1]. In one patient, colonic uptake was diagnosed as inflammatory. The mean standardized uptake valuemax (SUVmax) for the 12 premalignant lesions was 16.9 ± 9.6 (range 7.5-37.4) and the mean SUVmax for the 8 malignant lesions was 12.9 ± 5.5 (range 6.7-21.6). The difference in SUVmax between the premalignant adenomatous polyps and the malignant lesions was not statistically significant (P = 0.316).Conclusions:Our study shows that a significant proportion of patients (62.5%, 20/32) showing an incidental focal FDG uptake will harbor premalignant (adenomatous polyps) or malignant lesions, and further evaluation with colonoscopy and biopsy is warranted in such cases.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 67%

Etiology and significance of incidentally detected focal colonic uptake on FDG PET/CT

Purandare

Gawade

Puranik

et al. 2012

Indian J Radiol Imaging

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“…The overall sensitivity and specificity of PET/CT are higher compared with those of CT or magnetic resonance imaging (MRI) . PET/CT detects previously unknown malignant or premalignant lesions that are unrelated to the disease . Therefore, incidental findings might need additional workup and management, and they frequently cause confusion among physicians and patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact of incidental findings on integrated 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in patients with gastric cancer

Tae

Lee

Choi

et al. 2015

Asia-Pac J Clin Oncol

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“…FDG uptake can be diffuse, segmental or focal. Diffuse or segmental FDG uptake generally results from physiological or inflammatory processes 7 8 9 . In contrast, focal FDG uptake, which is observed in 0.4 % to 16.3 % of patients undergoing PET/CT examinations, is usually associated with the discovery of malignant and pre-malignant lesions in almost 68 % of patients 6 .…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, focal FDG uptake, which is observed in 0.4 % to 16.3 % of patients undergoing PET/CT examinations, is usually associated with the discovery of malignant and pre-malignant lesions in almost 68 % of patients 6 . Consequently, false-positive findings have been reported in 9.3 % to 63 % of these cases 9 10 11 12 13 14 15 16 17 18 19 20 21 22 . Although the mechanisms of FDG uptake in the large bowel are unclear, false-positive uptake is thought to be the consequence of the physiological accumulation of FDG 23 24 .…”

Section: Introductionmentioning

confidence: 99%

Incidental colorectal focal 18F-FDG uptake: a novel indication for colonoscopy

et al. 2017

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Background and study aims The relevance of incidental colorectal focal 18 F-FDG PET/CT uptake is debatable. All patients who were referred for colonoscopy because of incidental colonic focal FDG uptake were included in this retrospective study. Patients and methods PET/CT imaging characteristics were reviewed by a nuclear physician who was blinded to endoscopic and histopathological findings to determine the location of FDG uptake sites and to measure the maximum standardized uptake values (SUVmax) and metabolic volume (MV). Endoscopic findings were categorized as malignant lesions (ML), high-risk polyps (HRP), low-risk polyps (LRP) or other non-neoplastic lesions (NNL). Results Seventy patients with 84 foci of FDG uptake were included. The proportions of true-positive (lesions found at colonoscopy at the same location) and false-positive (no lesion at colonoscopy) PET/CT findings were 65.5 % (n = 55) and 34.5 % (n = 29). Median SUVmax values did not differ between true-positive and false-positive findings ( P = 0.27). Median MV30 values differed significantly between true-positive (5.5 cm 3 , [3.3 – 10.9 cm 3 ]) and false-positive (9.7 cm 3 , [5.2 – 40.8 cm 3 ]) findings ( P = 0.015). Among the 55 true-positive FDG uptake sites, there were 14 (25.5 %) malignant lesions, 30 (54.5 %) HRP, 4 (7.3 %) LRP, and 7 (12.7 %) NNL. Median MV30 values differed significantly between advanced neoplasia (5.0 cm 3 , [2.9 – 9.7 cm 3 ]) and other endoscopic findings (9.4 cm 3 , [5.2 – 39.8 cm 3 ]) ( P = 0.001); the AUROC was 0.71. By per-colonic segment analysis, the distribution of true-positive, false-negative, false-positive, and true-negative FDG PET/CT findings was as follows: 21.5 %, 14.2 %, 11.5 %, and 52.8 %, respectively. Conclusion Our study demonstrates that follow-up complete colonoscopy is mandatory in all patients with incidental colorectal focal 18 F-FDG PET/CT uptake.

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Clinical Relevance of Incidental Finding of Focal Uptakes in the Colon during 18F-FDG PET/CT Studies in Oncology Patients without Known Colorectal Carcinoma and Evaluation of the Impact on Management

Cited by 16 publications

References 26 publications

Etiology and significance of incidentally detected focal colonic uptake on FDG PET/CT

Etiology and significance of incidentally detected focal colonic uptake on FDG PET/CT

Impact of incidental findings on integrated 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in patients with gastric cancer

Incidental colorectal focal 18F-FDG uptake: a novel indication for colonoscopy

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