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Additional Value of Whole-Body Positron Emission Tomography With Fluorine-18-2-Fluoro-2-deoxy-D-glucose in Recurrent Colorectal Cancer

From the Departments of Nuclear Medicine, Internal Medicine, Abdominal Surgery, and Radiology, University Hospital Gasthuisberg and Catholic University of Leuven, Leuven, Belgium.

Address reprint requests to Patrick Flamen, MD, Department of Nuclear Medicine, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium; email patrick.flamen_uz.kuleuven.ac.be

PURPOSE: To assess the additional value of the whole-body [¹⁸F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan as a staging modality complementing conventional diagnostic methods (CDM) in patients suspected of having recurrent colorectal adenocarcinoma.

PATIENTS AND METHODS: In 103 patients, the discordances between FDG-PET and CDM results were identified and related to the final diagnosis obtained by histopathology or clinical follow-up (> 1 year). All FDG-PET studies were reviewed with full knowledge of the CDM findings.

RESULTS: In a region-based analysis, discordances between CDM and FDG-PET findings were found in 40 of 412 regions (10%). In these, FDG-PET had additional diagnostic value in 14 of 16 locoregional, six of seven hepatic, seven of eight abdominal, and eight of nine extra-abdominal regions. In a patient-based analysis, CDM categorized a subgroup of 60 patients as having resectable recurrent disease limited to the liver (n = 37) or locoregional region (n = 23). In 13 of these patients, there were discordant FDG-PET findings, detecting additional tumor sites in nine patients and excluding disease in three patients and yielding an additional diagnostic value in 20% of the patients. A second subgroup consisted of 13 patients with inconclusive CDM findings (n = 5) or with elevated plasma carcinoembryonic antigen levels and an otherwise negative conventional work-up (n = 8). In these patients, FDG-PET results were correct in eight of nine discordances, yielding a positive additional diagnostic value in 62% of the patients.

CONCLUSION: Whole-body FDG-PET can have a clear impact on the therapeutic management in the follow-up of patients with colorectal cancer.

Presented in part at the Annual Meeting of the American Society of Clinical Oncology, Los Angeles, CA, May 1998.

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