Clinical value of whole-body emission tomography in potentially curable  colorectal liver metastases.
OBJECTIVE
In selected patients with colorectal liver metastases, hepatic resection offers an opportunity for cure, with a 25-38% 5-year survival rate. The aim of this prospective study was to evaluate whether patient selection could be improved with pre-operative whole-body 18-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scan.


METHODS
Ninety-one consecutive patients were considered to be eligible for liver resection after investigation with conventional diagnostic methods (CDM). In all these patients a whole-body PET scan with FDG was performed prior to surgery. Follow-up was complete with a mean of 23 months (2 weeks-92 months). All PET images were reviewed blinded to intraoperative and follow-up data.


RESULTS
PET confirmed liver metastases in 90 (99%) patients, while it provided additional information in 10 (11%) patients, i.e., seven intra-abdominal, and three extra-abdominal. PET falsely upstaged six (6.6%) patients in whom malignancy was excluded by additional investigation, at the time of surgery, or during follow-up. PET falsely understaged seven (7.7%) patients with small intra-abdominal lesions.


CONCLUSIONS
In patients with potentially curable colorectal liver metastases according to conventional diagnostic methods, whole-body FDG-PET can be considered as a complementary examination in order to further select patients for potentially curative liver resection, and to optimize therapeutic strategy.
Topal
B
B
Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium. baki.topal@uz.kuleuven.ac.be
Flamen
P
P
Aerts
R
R
D'Hoore
A
A
Filez
L
L
Van Cutsem
E
E
Mortelmans
L
L
Penninckx
F
F
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003951:Diagnostic Errors; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014055:Tomography, Emission-Computed / Q000379:methods*; D014916:Whole-Body Irradiation
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18