Reliability of¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Nodal Staging of Colorectal Cancer Patients

Abstract

PurposeLymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known.MethodsThe medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition.ResultsThe patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05).ConclusionThe sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.

Clinical evaluation of18F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer

“…Notably, the diagnostic utility of PET/CT for lymph node staging has been described, 11,12 and recent technological advances, such as the addition of PSF to algorithm reconstructions, have improved the spatial resolution and signal-to-noise ratio. However, clinical studies involving 18 F-FDG-PET/CT with PSF reconstruction are lacking.…”

Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right-Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?

“…However, there appears to be no superior alternative imaging modality at present. A Korean study showed the sensitivity and specificity of FDG-PET/CT be inferior to CT for detecting metastases in regional lymph nodes in a cohort of 433 patients undergoing both CT and FDG-PET/CT prior to surgery for colorectal cancer [ 10 ]. Nerad et al [ 11 ] evaluated the accuracy of MRI for local staging of colon cancer in 55 patients, with all scans evaluated blindly by two experienced abdominal MRI radiologists.…”

Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging

“…Hybrid imaging: Qualitative evaluation with 18FDG-PET/CT for the assessment of nodal involvement has limited advantages compared to evaluation with CT[56,57], but a quantitative approach might be utilized to overcome this limitation. Tsunoda et al[58] compared the diagnostic accuracy of visual analysis and SUVmax evaluation for lymph node metastases using 18FDG-PET/CT in patients with CRC.…”