Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver

Vítola, João V.; Delbeke, Dominique; Sandler, Martin P.; Campbell, Michelle G.; Powers, Thomas A.; Wright, J. Kelly; Chapman, William C.; Pinson, C. Wright

doi:10.1016/s0002-9610(99)80067-1

Cited by 208 publications

(91 citation statements)

References 15 publications

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“…For abdominal CT scanning, the reports of liver evaluation for metastases show specificities of 50% to 90% and sensitivities of 43% to 72%.9 26 24 patients with colorectal metastases to the liver, CT had a sensitivity and specificity of 70% and 43%, respectively; PET had 100% specificity and 85% sensitivity. In another study of 76 patients with colorectal and liver metastases, CT scanning showed 60% and 72% sensitivity and specificity, respectively.9 However, PET scanning of the same patients revealed 93% sensitivity and 97% specificity for liver metastases.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

Holder

White²,

Zuger³

et al. 1998

Annals of Surgery

237

180

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ObjectiveThe purpose of this study was to determine the sensitMty, specificity, and clinical utility of 18F 2-fluoro-2-deoxy-D-glucose (FDG) totalbody positron emission tomography (PET) scanning for the detection of metastases in patients with malignant melanoma. Summary Background DataRecent preliminary reports suggest that PET using FDG may be more sensitive and specific for detection of metastatic melanoma than standard radiologic imaging studies using computed tomography (CT). PET technology is showing utility in the detection of metastatic tumors from multiple primary sites including breast, lung, lymphoma, and melanoma. However, little information is available concerning the general utility, sensitMty, and specificity of PET scanning of patients with metastatic melanoma. MethodsOne hundred three PET scans done on 76 nonrandomized patients having AJCC stage 11 to IV melanoma were prospectively evaluated. Patients were derived from two groups. Group 1 (63 patients) had PET, CT (chest and abdomen), and magnetic resonance imaging (MRI; brain) scans as a part of staging requirements for immunotherapy protocols. Group 2 (13 nonprotocol patients) had PET, CT, and MRI scans as in group 1, but for clinical evaluation only. PET scans were done using 12 to 20 mCi of FDG given intravenously. Results of PET scans were compared to CT scans and biopsy or cytology results. ResultsPET scanning for the detection of melanoma metastases had a sensitivity of 94.2% and a specificity of 83.3% compared to 55.3% and 84.4%, respectively, for CT scanning. Factors that produced false-positive PET scans were papillary carcinoma of the thyroid (1), bronchogenic carcinoma (1), inflamed epidermal cyst (1), Warthin's tumor of the parotid gland (1), surgical wound inflammation (2), leiomyoma of the uterus (1), suture granuloma (1), and endometriosis (1). The four false-negative scans were thought to be due to smaller (<0.3 to 0.5 cm) and diffuse areas of melanoma without a mass effect. ConclusionsPET scanning is extremely sensitive (94.2%) and very specific (83.3%) for identifying metastatic melanoma, particularly in soft tissues, lymph nodes, and the liver. A number of second primary or metastatic tumors and an inflammatory response can also be localized by PET. This observation mandates a close clinical correlation with positive PET and emphasizes the importance of establishing a tissue diagnosis. False-negative scans in the presence of metastases are rare (4% of scans). Metastases <5 mm in diameter may not image well. PET is superior to CT in detecting melanoma metastases and has a role as a primary strategy in the staging of melanoma. 764 melanoma is easily excised and often cured. As melanoma spreads more deeply into the skin and involves regional lymph nodes, the rate of development of metastatic disease in surgically resected patients often exceeds 50% within 5 years.2 Increasing numbers of diagnostic and treatment strategies, primarily sentinel lymph node biopsy and immunotherapeutic treatments, are based on the early detection of ...

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

Holder

White²,

Zuger³

et al. 1998

Annals of Surgery

237

180

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“…Of note, 18 FDG-PET has proven extremely accurate in our institution for the detection of metastatic colorectal carcinoma and in the differentiation between benign and malignant lesions of the liver. [22][23][24] However, the 18 FDG-PET images are evaluated both visually and semiquantitatively using an objective value based on local 18 FDG concentration corrected for injected dosage per body weight (the SUR). In the reported series, the cutoff SUR for identification of malignancy ranged from 1.5 to 4.0, with widely variant mean values for benign and malignant lesions.…”

Section: Discussionmentioning

confidence: 99%

“…16,18,20,[22][23][24] The use of 18 FDG-PET in the evaluation of suspected recurrent pancreatic adenocarcinoma has not yet been reported. In the eight patients evaluated for possible recurrence in this series, all were noted to have significant new regions of 18 FDG uptake, and all proved to have metastatic pancreatic adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

et al. 1999

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ObjectiveTo assess the accuracy and clinical impact of 18 fluorodeoxyglucose-positron emission tomography ( 18 FDG-PET) on the management of patients with suspected primary or recurrent pancreatic adenocarcinoma, and to assess the utility of 18 FDG-PET in grading tumor response to neoadjuvant chemoradiation. Summary Background DataThe diagnosis, staging, and treatment of pancreatic cancer remain difficult. Small primary tumors and hepatic metastases are often not well visualized by computed tomographic scanning (CT), resulting in a high incidence of nontherapeutic celiotomy and the frequent need for "blind resection." In addition, the distinction between local recurrence and nonspecific postoperative changes after resection can be difficult to ascertain on standard anatomic imaging. 18FDG-PET is a new imaging technique that takes advantage of increased glucose metabolism by tumor cells and may improve the diagnostic accuracy of preoperative studies for pancreatic adenocarcinoma. Methods Eighty-one18 FDG-PET scans were obtained in 70 patients undergoing evaluation for suspected primary or recurrent pancreatic adenocarcinoma. Of this group, 65 underwent evaluation for suspected primary pancreatic cancer. Nine patients underwent 18 FDG-PET imaging before and after neoadjuvant chemoradiation, and in eight patients 18 FDG-PET scans were performed for possible recurrent adenocarcinoma after resection. The 18 FDG-PET images were analyzed visually and semiquantitatively using the standard uptake ratio (SUR). The sensitivity and specificity of 18 FDG-PET and CT were determined for evaluation of the preoperative diagnosis of primary pancreatic carcinoma, and the impact of 18 FDG-PET on patient management was retrospectively assessed. ResultsAmong the 65 patients evaluated for primary tumor, 52 had proven pancreatic adenocarcinoma and 13 had benign lesions.18 FDG-PET had a higher sensitivity and specificity than CT in correctly diagnosing pancreatic carcinoma (92% and 85% vs. 65% and 62%). Eighteen patients (28%) had indeterminate or unrecognized pancreatic masses on CT clarified with 18 FDG-PET. Seven patients (11%) had indeterminate or unrecognized metastatic disease clarified with 18 FDG-PET. Overall, 18FDG-PET suggested potential alterations in clinical management in 28/65 patients (43%) with suspected primary pancreatic adenocarcinoma. Of the nine patients undergoing 18 FDG-PET imaging before and after neoadjuvant chemoradiation, four had evidence of tumor regression by PET, three showed stable disease, and two showed tumor progression. CT was unable to detect any response to neoadjuvant therapy in this group. Eight patients had 18 FDG-PET scans to evaluate suspected recurrent disease after resection. Four were noted to have new regions of 18 FDG-uptake in the resection bed; four had evidence of new hepatic metastases. All proved to have metastatic pancreatic adenocarcinoma. ConclusionsThese data confirm that 18 FDG-PET is useful in the evaluation of patients with suspected primary or recurrent pancreatic carcinoma.18...

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“…Animal experiments with human gastric cancer xenografts also showed that FDG uptake is correlated with the differentiation of the tumour (Yoshioka et al, 1994). PET has already established a role in the staging of other tumours such as lung cancer and colon cancer (Valk et al, 1995;Vitola et al, 1996;Delbeke et al, 1997;Guhlmann et al, 1997;Steinert et al, 1997). The current study was undertaken to investigate FDG-PET prospectively as a means of detecting metastatic disease in patients with oesophageal tumours and of comparing the reliability of diagnostic assessment of PET with CT, with the surgical and histological findings as a gold standard.…”

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confidence: 98%

Positron emission tomography for staging of oesophageal and gastroesophageal malignancy

Kole

Plukker²,

Nieweg³

et al. 1998

Br J Cancer

166

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Summary Positron emission tomography (PET) with [18F]-fluoro-2-deoXy-D-glucose (FDG) was prospectively investigated as a means of detecting metastatic disease in patients with oesophageal tumours and compared with computerized tomography (CT), with the surgical findings as a gold standard. Twenty-six patients with a malignant tumour of the oesophagus or gastroesophageal junction underwent CT and PET of the chest and the abdomen. Seven patients underwent laparoscopy to establish resectability. Fifteen patients underwent laparotomy without prior laparoscopy. Four patients did not undergo surgery. The primary tumour was visualized in 81% of patients with CT and in 96% with PET. Neither CT nor PET were suited to assess the extent of wall invasion. Surgically assessed nodal status corresponded in 62% with CT and in 90% with PET. Distant metastases were found in five patients with CT and in eight with PET. The diagnostic accuracy of CT in determining resectability was 65% and for PET 88%. For CT and PET together this was 92%. The present study indicates that FDG-PET can be of importance for staging patients with oesophageal tumours. PET has a higher sensitivity for nodal and distant metastases and a higher accuracy for determining respectability than CT. PET and CT together would have decreased ill-advised surgery by 90%.

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Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver

Cited by 208 publications

References 15 publications

Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

Effectiveness of Positron Emission Tomography for the Detection of Melanoma Metastases

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

Positron emission tomography for staging of oesophageal and gastroesophageal malignancy

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