title: Routine use of positron-emission tomography/computed tomography for staging of primary colorectal cancer: does it affect clinical management?
abstract: BACKGROUND
  The use of positron emission tomography-computed tomography (PET/CT) for the preoperative staging of patients with colon and rectal cancer has increased steadily over the last decade. The aim of this study was to evaluate the effect of PET/CT on the preoperative staging and clinical management of patients with colorectal cancer.
  
  
  METHODS
  Between December 2010 and February 2012, 64 consecutive patients with colorectal cancer were evaluated with both PET/CT scans and conventional preoperative imaging studies. We prospectively recorded the medical reports of these patients. The PET/CT findings were compared with conventional imaging studies and the rate of over-staging or down-staging and changes in clinical management were evaluated. The correlation of the PET/CT with the conventional imaging was compared by a kappa agreement coefficient. Differences in the accuracy for N and T staging were assessed by χ2 and related-samples marginal homogeneity tests.
  
  
  RESULTS
  Thirty-nine (60.9%) patients had rectal cancer and 25 (39.1%) had colon cancer. Based on PET/CT, additional lesions were found in 6 (9.4%) of the patients: hilar and paratracheal lesions in 4 patients, hepatic in 1 and supraclavicular in 1 patient. In four of six patients, detailed imaging studies or biopsies revealed chronic inflammatory changes. Hepatic and supraclavicular involvement was confirmed in two patients. Therefore, the false positivity rate of PET/CT was 6.25%. Based on the additional PET/CT, 2 (3.2%) patients had a change in surgical management. A chemotherapy regimen was administered to the patient with a 1.5 cm hepatic metastasis near the right hepatic vein; for another patient with an identified supraclavicular lymph node metastasis, a simultaneous excision was performed.
  
  
  CONCLUSIONS
  Routine use of PET/CT for preoperative staging did not impact disease management for 96.8% of our patients. The results of our study conclude that PET/CT should not be routinely used for primary staging of colorectal cancer. More studies are required for identifying the subgroup of patients who might benefit from a PET/CT in their initial staging.
authors: Faculty of Medicine, Department of General Surgery, Bezmialem Vakif University, Adnan Menderes Bulvari, Istanbul, Fatih 34090, Turkey. gokhancipe@hotmail.com
authors: Gokhan
authors: G
authors: Cipe
authors: Nurhan
authors: N
authors: Ergul
authors: Mustafa
authors: M
authors: Hasbahceci
authors: Deniz
authors: D
authors: Firat
authors: Suleyman
authors: S
authors: Bozkurt
authors: Naim
authors: N
authors: Memmi
authors: Oguzhan
authors: O
authors: Karatepe
authors: Mahmut
authors: M
authors: Muslumanoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult