[Use of PET-CT in pre-surgical staging of colorectal cancer hepatic metastases].
BACKGROUND
Unsuspected intrahepatic and extrahepatic metastases are frequently discovered at laparotomy in patients with resectable colorectal liver metastases (CLM), and 60% of these patients will develop a recurrent tumour within 3 years, after a "curative" liver resection. These findings strongly support the need for more effective preoperative staging. The combined positron emission tomography-computed tomography technique (PET-CT) has emerged as a promising diagnostic modality for determining whether patients with recurrent disease in the liver are suitable candidates for curative resection.


OBJECTIVE
The aim of this study was to assess the additional value of information provided by PET-CT compared to that of conventional radiological studies (CT and MR) in patients with resectable CLM.


METHODS
Between June 2006 and August 2007, 63 patients evaluated for a first resection of CLM were entered into a prospective database. Each patient received a CT-MR and a PET-CT. Forty-three patients underwent a laparotomy and 42 a hepatectomy. The main end point of the study was to assess the impact of the PET-CT findings on the therapeutic strategy.


RESULTS
New findings in the PET-CT resulted in a change in the therapeutic strategy in 9 (14%) of the patients. However, PET-CT provided additional information was true positive by revealing abdominal extrahepatic metastases only in 4 (6.4%) patients, and falsely over-staged four patients and under staged one patient. Lesion-by-lesion sensitivity and predictive positive value for liver lesions were 78,4% and 96% for CT-MR alone, and 55% and 100% for PET-CT respectively. PET-CT was superior to CT-MR for the detection of local recurrence at the site of the initial colorectal surgery.


CONCLUSIONS
In the selection of patients with CLM being considered for surgical therapy, PET-CT provided useful information only in 6.4% of cases. Possibly longer follow-up will increase this percentage. Our findings support the use of PET-CT mainly in patients with high risk of local recurrence.
Ramos
Emilio
E
Servicio de Cirugía General. Unidad de Cirugía Hepática. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España. eramos@csub.scs.es
Martínez
Laura
L
Gámez
Cristina
C
Torras
Jaume
J
Valls
Carles
C
Rafecas
Antoni
A
Lladó
Laura
L
Jorba
Rosa
R
Ruiz
Sandra
S
Serrano
Teresa
T
Fabregat
Joan
J
D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed