Incidental focal uptake in colorectal location on oncologic FDG PET and PET/CT studies: Histopathological findings and clinical significances

Fuertes, Jordi; Montagut, Clara; Bullich, Santi; Coma, Mar Iglesias; Mestre-Fusco, Antoni; Suárez-Piñera, Marina; Trampal, Carlos; Bellmunt, Joaquim

doi:10.1016/j.remn.2014.07.008

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…Initial detection rate of incidental colonic findings might be as high as 10% due to the high mean age of the patients included ( 13 ). Lower levels of incidental detection rate of 1.17% was also reported, which is attributed to the inclusion criteria of the study that restricted patients only to meet the strict criteria for focal colonic uptake ( 14 ).…”

Section: Discussionmentioning

confidence: 97%

Prevalence and Clinical Significance of Incidental Focal <sup>18</sup>F-FDG Uptake in Colon on PET/CT Imaging

Gökden

Özülker

2022

Mirt

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Objectives: The present study aimed to identify the prevalence of focal uptake in the colon on 18 fluorine-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) studies performed for the evaluation of malignancies other than colon, to detect the rate of malignancy in incidental focal 18 F-FDG avid colonic lesions and to investigate if any possible role of maximum standardized uptake value (SUV max ) values in the discrimination of malignant lesions from premalignant and benign ones exist. Methods: We retrospectively reviewed the files of 8,017 patients with known or suspected malignancy, who underwent whole-body 18 F-FDG PET/CT at our institution during the period November 2017 to November 2019. Patients showing a single site of focally increased colonic 18 F-FDG uptake that was more intense compared to liver uptake on 18 F-FDG PET studies and referred to colonoscopy were enrolled in the study. Results: Fifty two patients (83.8%) had at least 1 corresponding lesion on colonoscopy, whereas in 10 patients no lesion was detected. Subsequent histopathological examinations revealed no corresponding lesion in 13 (13.7%), a benign lesion in 18 (18.9%), hyperplastic polyp in 10 (10.5%), low-grade polyp in 16 (16.8%), high-grade polyp in 29 (30.5%) and malignant lesion in 9 (9.5%) of the focal 18 F-FDG uptake sites. According to histopathology results, statistically no significant difference was found between the SUV max measurements of malignant and benign cases (p>0.05) but the average SUV max measurements of malignant cases were found to be significantly higher than lower + high-grade cases (p<0.05) and hyperplastic polyp cases (p<0.01). Conclusion: In conclusion, any unexpected focal 18 F-FDG uptake in 18 F-FDG PET/CT studies is suspicious for malignancy and should be clarified by colonoscopy. The intensity of 18 F-FDG uptake does not preclude the application of colonoscopy and histopathological verification of the lesion if there is any.

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Section: Discussionmentioning

confidence: 97%

Prevalence and Clinical Significance of Incidental Focal <sup>18</sup>F-FDG Uptake in Colon on PET/CT Imaging

Gökden

Özülker

2022

Mirt

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“…All except 1 of these polyps were FDG-avid. Although this particular histopathological group has been previously mentioned in FDG studies 13 , it is interesting to note that not only advanced adenomas but also sessile serrated polyps with dysplasia could be associated with FDG uptake. Because these lesions are at high risk of malignant transformation 30 , early detection may improve patient outcome.…”

Section: Discussionmentioning

confidence: 81%

“…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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“…However, the experience with PET-CT is limited and a consensus recommendation in terms of clinical application is still under assessment. Therefore, the use of colonoscopy and a histological study of colonic uptakes are the standard for subsequent evaluations (10,11).…”

Section: Discussionmentioning

confidence: 99%

Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT

et al. 2018

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Incidental focal uptake in colorectal location on oncologic FDG PET and PET/CT studies: Histopathological findings and clinical significances

Cited by 11 publications

References 22 publications

Prevalence and Clinical Significance of Incidental Focal <sup>18</sup>F-FDG Uptake in Colon on PET/CT Imaging

Prevalence and Clinical Significance of Incidental Focal <sup>18</sup>F-FDG Uptake in Colon on PET/CT Imaging

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

Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT

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