The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver.
OBJECTIVE
To compare the accuracy of whole-body position emission tomography (PET)using [18F]fluorodeoxyglucose (FDG) with conventional radiological imaging techniques in identifying operable colorectal cancer metastases to the liver.


METHODS
A double-blind comparative study of FDG-PET as the criterion standard vs conventional radiological imaging methods as the criterion standard, in staging of recurrent colorectal cancer.


METHODS
Institutional practice in a tertiary referral center.


METHODS
Thirty-four consecutive patients with suspected colorectal cancer metastases recruited for the study between May 1993 and October 1994.


METHODS
Conventional radiological methods of cancer staging included abdominal computed tomography (CT) (n = 34), chest x-rays (n = 15), and chest CT (n = 19) to evaluate extrahepatic disease. Twenty-seven patients were subsequently considered to have apparently isolated cancer metastases to the liver. Anatomical resectability was assessed by magnetic resonance imaging (n = 24) or CT angiography (n = 3) in all study patients. The FDG-PET studies (n = 34) were performed within 8 weeks of conventional radiological imaging.


METHODS
Malignancy of suspected lesions detected by means of FDG-PET and conventional radiological imaging was confirmed by histopathologic examination of resected specimens and percutaneous biopsy specimens and by serial CT scans demonstrating progression of disease.


RESULTS
Unsuspected extrahepatic malignant disease that was missed by conventional radiological imaging was detected by FDG-PET in 11 patients (32%). The PET-detected extrahepatic malignant disease included retroperitoneal nodal metastases (n = 6), pulmonary metastases (n = 3), and locoregional cancer recurrences (n = 2). The additional information afforded by PET consequently had an influence on the clinical management in 10 patients (29%).


CONCLUSIONS
The FDG-PET method enabled selection of patients with apparently curable colorectal cancer metastases to the liver for hepatic resection.
Lai
D T
DT
Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.
Fulham
M
M
Stephen
M S
MS
Chu
K M
KM
Solomon
M
M
Thompson
J F
JF
Sheldon
D M
DM
Storey
D W
DW
D015179:Colorectal Neoplasms / Q000473:pathology*; D003847:Deoxyglucose / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D009364:Neoplasm Recurrence, Local; D011859:Radiography; D014055:Tomography, Emission-Computed
D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose