Comparison of Conventional Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnostic Accuracy of Staging in Patients with Intrahepatic Cholangiocarcinoma

Abstract

We aimed to examine the accuracy of tumor staging of intrahepatic cholangiocarcinoma (ICC) by using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT). From January 2001 to December 2021, 202 patients underwent PET-CT, CT, and MRI for the initial staging of ICC in two institutions. Among them, 102 patients had undergone surgical treatment. Ninety patients who had a histopathological diagnosis of ICC were retrospectively reviewed. The sensitivity and specificity of 18F-FDG PET-CT, CT, and magnetic resonance imaging (MRI) in detecting tumors, satellite focus, vascular invasion, and lymph node metastases were analyzed. Ninety patients with histologically diagnosed ICC were included. PET-CT demonstrated no statistically significant advantage over CT and MR in the diagnosis of multiple tumors and macrovascular invasion, and bile duct invasion. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT in lymph node metastases were 84%, 86%, 91%, 84%, and 86%, respectively. PET-CT revealed a significantly higher accuracy compared to CT or MRI (86%, 67%, and 76%, p < 0.01, respectively) in the diagnosis of regional lymph node metastases. The accuracy of tumor staging by PET-CT was higher than that by CT/MRI (PET-CT vs. CT vs. MRI: 68/90 vs. 47/90 vs. 51/90, p < 0.05). 18F-FDG PET-CT had sensitivity and specificity values for diagnosing satellite focus and vascular and bile duct invasion similar to those of CT or MRI; however, PET-CT showed higher accuracy in diagnosing regional lymph node metastases. 18F-FDG PET-CT exhibited higher tumor staging accuracy than that of CT/MRI. Thus, 18FDG PET-CT may support tumor staging in ICC.

Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma

“…The theme of recurrence was also explored through MRI. The results achieved were comparable to the ones achieved by CT images analysis [ 192 , 193 , 194 , 195 , 196 ]. In the study by Xu et al, to predict early and late recurrence, features were extracted from the intratumoral and peritumoral area.…”

Impact of Lymph Node Dissection for Patients With Clinically Node-Negative Intrahepatic Cholangiocarcinoma: A Multicenter Cohort Study

“…However, previous studies reported that the sensitivity and specificity of CT/MRI varied from 35.0% to 78.2% [ 30 , 31 ], which strongly calls for more precise detection methods. Recent studies reported that 18-F fluorodeoxyglucose (FDG) PET-CT [ 32 , 33 ] showed significantly higher sensitivity, specificity and accuracy than conventional CT/MRI in diagnosing regional LNM, which may facilitate tumor staging in ICC. Besides, artificial intelligence-based radiomics [ 34 , 35 ] also performed well in metastatic nodal discrimination, enabling accurate N staging of ICC and patient risk stratification.…”

18F-fluorodeoxyglucose positron emission tomography/computed tomography in intrahepatic cholangiocarcinoma: could it be a new paradigm?

“…Lin et al reported that 18 F-FDG PET/CT is more effective than CT/MRI in identifying lymph node and distant metastases ( 10 ). They first identified several points of interest for 18 F-FDG PET/CT in the initial staging of iCCA: the detection ability of 18 F-FDG PET has a clinically important impact on tumor-node-metastasis (TNM) staging and treatment planning for iCCA ( 11 ), and the ability of 18 F-FDG PET/CT to detect distant metastases in the early stages of iCCA is of great importance in the staging of iCCA. Detected distant metastases may be missed by CT/MRI, but can be accurately identified by 18 F-FDG PET/CT.…”

“…Some studies have reported that lymph node status is highly related to the prognosis of iCCA ( 11 , 12 ). Lin et al also reported that treatment allocation was significantly different, with 83.6% of patients treated curatively with conventional imaging and 90.5% of patients treated with both PET/CT and conventional imaging (P=0.033), establishing the influence of PET/CT on clinical treatment strategy (P=0.033), demonstrating the impact of PET/CT on clinical treatment strategies.…”