Use of FDG-PET/CT for peritoneal carcinomatosis before hyperthermic intraperitoneal chemotherapy

Berthelot, C.; Morel, Olivier; Girault, Sylvie; Verrièle, Véronique; Poirier, Anne-Lise; Moroch, Julien; Boucher, Yvan; Jeune, Jean‐Jacques Le; Lorimier, G.

doi:10.1097/mnm.0b013e328340e730

Cited by 27 publications

(21 citation statements)

References 23 publications

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“…Metabolic imaging with FDG-PET/CT has already proved its usefulness in the management of patients with digestive cancer [9]. However, there are only limited data available on the value of these techniques in assessing PC staging [6,7,[10][11][12]. Moreover, to our knowledge, intraindividual head-to-head comparison of both FDG-PET/CT and MR-DWI has, to date, not been reported.…”

Section: Introductionmentioning

confidence: 99%

Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy

et al. 2012

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Section: Introductionmentioning

confidence: 99%

Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy

et al. 2012

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“…All imaging modalities have limitations when it comes to diagnosing PC, but PET-CT appears to be the most sensitive. 4 Diagnosis is more frequently and accurately found during laparoscopy or laparotomy. 1 Treatment of PC remains controversial and generally limited or palliative.…”

Section: Discussionmentioning

confidence: 99%

Localized peritoneal carcinomatosis mimicking an irreducible left inguinal hernia

Buchs

Bloemendaal

Guy

2016

annals

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Perforated colonic cancers are not rare and leave patients at risk of developing peritoneal carcinomatosis. We present a 68-year-old male patient with a perforated transverse colonic tumour who underwent emergency extended right hemicolectomy. He made an uneventful postoperative recovery, and received adjuvant chemotherapy. Unfortunately, a routine positron emission tomography-computed tomography scan 16 months later demonstrated an fluorodeoxyglucose-avid nodule in the left scrotum associated with an irreducible left inguinal hernia that contained sigmoid colon. At laparotomy, the discovery of isolated peritoneal recurrence in the hernia sac was unexpected, given the absence of local recurrence in the region of the original transverse colon cancer perforation. The etiology therefore remains uncertain, but one may speculate that cell implantation occurred within the hernia sac at the initial emergency laparotomy. Whilst PC is not rare, its management and its preoperative diagnosis in particular remain challenging. Only 40% of patients can be diagnosed by imaging modalities and, in many of them, PC will be found only at the time of surgery. 1 We present an interesting case of peritoneal recurrence, mimicking an irreducible inguinal hernia. Case presentationA 68-year-old male with a known left inguinal hernia was admitted with acute abdominal pain and peritonitis. Abdominal computed tomography (CT) identified a perforated transverse colonic tumour. He underwent emergency extended right hemicolectomy, abdominal washout, curettage and omental obliteration of a cavity in the left upper quadrant, and received a primary ileocolic anastomosis. He made an uneventful postoperative recovery. Pathological examination showed a Dukes' B (pT4N0Ly1V1R0) adenocarcinoma and the patient received an adjuvant FOLFIRI chemotherapy regimen.Sixteen months later, routine positron emission tomography-computed tomography (PET-CT) scan demonstrated an fluorodeoxyglucose-avid nodule in the left hemiscrotum that was associated with both a left inguinal hernia containing sigmoid colon and a further nodule at the neck of the scrotum (Figures 1 and 2). Clinically, the hernia was irreducible, although there was no sign of obstruction or strangulation. There was no obvious testicular mass. A flexible sigmoidoscopy did not reveal any intraluminal colonic lesion.At laparotomy, and following reduction of the sigmoid colon out of the hernia sac, a nodule was found on the sigmoid serosa, and another at the neck of the sac adjacent to the pubic tubercle. Macroscopic disease was not seen anywhere else in the abdomen. On-table colonoscopy confirmed the absence of mucosal disease, and a limited segmental sigmoid resection, preserving the inferior mesenteric artery (IMA), and a separate resection of the peritoneal sac and second nodule were performed. Metastatic adenocarcinoma was confirmed microscopically in the two nodules. While three mesenteric lymph nodes were also positive for adenocarcinoma, no luminal cancer was detected. All disease was i...

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“…Due to the promising results in the preoperative assessment of PC, F-18-FDG PET/CT seems to be an optimal technique to evaluate patients after HIPEC as it is at least comparable if not better than other imaging modalities in the preoperative setting [12]. One aspect in favor of PET/CT is its ability to assess tissue metabolism thus helping to differentiate between malignant tumor and postoperative scar in patients in whom morphologic assessment alone is insufficient [30]. Based on our results, PET/CT seems to perform well also in the follow-up after HIPEC with an overall diagnostic accuracy of 91 % for the detection of PC on a patient basis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy using F-18-FDG-PET/CT

Klumpp

Schwenzer

Gatidis

et al. 2014

Fortschr Röntgenstr

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Purpose: In patients with peritoneal carcinomatosis (PC), cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving therapeutic approach with curative intention. The differentiation between posttherapeutic findings after HIPEC and relapse of PC is challenging. We evaluated the diagnostic value of F-18-FDG-PET/CT in patients with relapse of PC after HIPEC. Materials and Methods: 36 patients with recurring PC after HIPEC were examined on a whole-body PET/CT system (44 examinations). The examination included 3?D F-18-FDG-PET and contrast-enhanced CT. Images were assessed by two experienced readers regarding the presence and the extent of PC using the peritoneal carcinomatosis index (PCI). Imaging results were correlated with surgical findings or follow-up. Results: Relapse was suspected in 40 of 44 examinations. Relapse was missed by F-18-FDG PET/CT in 4 patients and significantly underestimated in 8 patients. The diagnostic accuracy for the detection of PC on a patient basis was 91?%, the sensitivity was 91?% and the positive predictive value was 100?%. The mean PCI was 11.4???11.9 for PET/CT, 8.4???10.3 for CT and 16.6???15.0 in the case of surgical exploration. The extent of PC was underestimated by PET/CT and even more by CT alone (p?

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Use of FDG-PET/CT for peritoneal carcinomatosis before hyperthermic intraperitoneal chemotherapy

Abstract: PET presented a good performance level in the diagnosis and evaluation of the extent of PC. PET/CT examinations could be useful to avoid unnecessary surgery.

Cited by 27 publications

References 23 publications

Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy

Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy

Localized peritoneal carcinomatosis mimicking an irreducible left inguinal hernia

Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy using F-18-FDG-PET/CT

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