Fluorine-18 fluorodeoxyglucose positron emission tomography predicts lymph node metastasis, P-glycoprotein expression, and recurrence after resection in mass-forming intrahepatic cholangiocarcinoma.
BACKGROUND
Patients with intrahepatic cholangiocarcinoma (ICC) have a poor prognosis, and lymph node metastasis is an important prognostic factor. In this study, we investigated the usefulness of fluorodeoxyglucose positron emission tomography (FDG-PET) as a marker for lymph node metastasis, P-glycoprotein (P-gp) expression, and recurrence in ICC.


METHODS
The subjects were 35 patients who underwent FDG-PET. Detectability of lymph node metastasis using FDG-PET was compared with that using computed tomography (CT) or magnetic resonance imaging (MRI). In patients who underwent resection, expression of P-gp was examined immunohistochemically, and the relationship between P-gp expression and the standardized uptake value (SUV) in FDG-PET was investigated. Survival rates were analyzed using clinical and pathologic factors.


RESULTS
Of the 35 patients, 5 did not undergo surgery based on FDG-PET findings (2 with extrahepatic metastasis, and 3 with para-aortic lymph node metastasis) and 3 underwent laparotomy only (2 with peritoneal dissemination and 1 with para-aortic lymph node metastasis). The diagnostic accuracies of FDG-PET, CT, and MRI for detection of lymph node metastasis were 86%, 68%, and 57%, the sensitivities were 43%, 43% and 43%, and the specificities were 100%, 76%, and 64%, respectively. A negative correlation was found between SUV and P-gp expression (P = .002; r = -0.62). The disease-free survival rates in the high SUV group (>or=8.5) were significantly lower than in the low SUV group (<8.5; P = .04), and a high SUV was an independent predictor of postoperative recurrence in multivariate analysis (risk ratio, 1.3; P = .03).


CONCLUSIONS
FDG-PET is useful for prediction of lymph node metastasis, P-gp expression and recurrence in ICC.
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Satoru
S
Seo
Etsuro
E
Hatano
Tatsuya
T
Higashi
Akio
A
Nakajima
Yuji
Y
Nakamoto
Masaharu
M
Tada
Nobuyuki
N
Tamaki
Keiko
K
Iwaisako
Akira
A
Mori
Ryuichiro
R
Doi
Iwao
I
Ikai
Shinji
S
Uemoto
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics / Q000378:metabolism*; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D019788:Fluorodeoxyglucose F18