title: A comparison of positron emission tomography and colonoscopy for the detection of advanced colorectal neoplasms in subjects undergoing a health check-up.
abstract: OBJECTIVE
  There is no agreement as to whether F-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) screening for advanced colorectal neoplasms is meaningful. This retrospective study was undertaken to determine whether FDG PET/CT may be a valuable screening tool for the detection of advanced colorectal neoplasms.
  
  
  METHODS
  A retrospective review of the records of 1,109 FDG PET/CT scans acquired from January 2007 to December 2011 was performed. Colonoscopy and FDG PET/CT imaging were performed within two days of each other. The results of colonoscopy were taken as the gold standard, either with or without the results of the histopathological examination. An advanced neoplasm was defined as the presence of a malignant tumor, an adenoma ≥1 cm, or histological evidence of high-grade dysplasia or significant villous components.
  
  
  RESULTS
  A total of 36 subjects had advanced colorectal neoplasms detected by colonoscopy (totaling 38 neoplasms). Six of the 38 neoplasms were also detected by FDG PET/CT. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of FDG PET/CT in the detection of advanced colorectal neoplasms were 15.8% (6/38), 99.1% (1063/1073), 37.5% (6/16), 97.1% (1063/1095), and 96.2% (1069/1111) respectively. The presence of lesions with an endoscopic size ≤1.5 cm (P<0.001) and low-grade dysplasia (P<0.001) were the main predictors of false-negative FDG PET/CT findings.
  
  
  CONCLUSIONS
  We conclude that FDG PET/CT screening of advanced colorectal neoplasms is unwarranted, especially in the presence of lesions with an endoscopic size ≤1.5 cm or low-grade dysplasia.
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Shu-Wei
authors.initials: SW
authors.lastname: Huang
authors.forename: Chen-Ming
authors.initials: CM
authors.lastname: Hsu
authors.forename: Wen-Juei
authors.initials: WJ
authors.lastname: Jeng
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Ming-Yao
authors.initials: MY
authors.lastname: Su
authors.forename: Cheng-Tang
authors.initials: CT
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
references.citation: Gastroenterology. 2008 May;134(5):1570-95
references.pmid: 18384785
references.citation: Gastrointest Endosc. 2005 Apr;61(4):547-53
references.pmid: 15812407
references.citation: Radiology. 2005 Dec;237(3):893-904
references.pmid: 16304111
references.citation: Am J Gastroenterol. 2006 Dec;101(12):2711-6
references.pmid: 17227517
references.citation: Dig Liver Dis. 2010 Mar;42(3):185-90
references.pmid: 19643688
references.citation: Colorectal Dis. 2012 Feb;14(2):174-80
references.pmid: 21689289
references.citation: Eur J Nucl Med Mol Imaging. 2003 Jan;30(1):40-5
references.pmid: 12483408
references.citation: J Nucl Med. 2004 Jan;45(1):22-9
references.pmid: 14734665
references.citation: N Engl J Med. 2000 Jul 20;343(3):162-8
references.pmid: 10900274
references.citation: Gut. 2008 Aug;57(8):1166-76
references.pmid: 18628378
references.citation: Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3-43
references.pmid: 14652541
references.citation: Ann Nucl Med. 2008 Jun;22(5):379-85
references.pmid: 18600415
references.citation: J Nucl Med. 2011 Feb;52(2):180-7
references.pmid: 21270454
references.citation: J Nucl Med. 2001 Jul;42(7):989-92
references.pmid: 11438616
references.citation: Clin Gastroenterol Hepatol. 2009 Dec;7(12):1272-8
references.pmid: 19523536
references.citation: J Gastroenterol Hepatol. 2012 Jan;27(1):76-80
references.pmid: 21649720
references.citation: N Engl J Med. 2000 Jun 15;342(24):1766-72
references.pmid: 10852998
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: J Nucl Med. 1998 Jun;39(6):1030-3
references.pmid: 9627339
references.citation: Clin Gastroenterol Hepatol. 2011 Dec;9(12):1025-32
references.pmid: 21723237
references.citation: J Clin Oncol. 2005 Jun 1;23(16):3713-7
references.pmid: 15923568
references.citation: Gastrointest Endosc. 2003 Jul;58(1):36-40
references.pmid: 12838218
references.citation: AJR Am J Roentgenol. 2009 Mar;192(3):754-60
references.pmid: 19234274
references.citation: Cancer. 1975 Dec;36(6):2251-70
references.pmid: 1203876
references.citation: Semin Nucl Med. 2004 Jul;34(3):209-23
references.pmid: 15202102
references.citation: Ann Nucl Med. 2007 Nov;21(9):481-98
references.pmid: 18030580
references.citation: Gastrointest Endosc. 2005 Mar;61(3):395-400
references.pmid: 15758910
references.citation: Gastrointest Endosc. 2006 Apr;63(4):546-57
references.pmid: 16564851
references.citation: J Nucl Med. 2000 Jul;41(7):1177-89
references.pmid: 10914907
references.citation: Gut. 2000 Aug;47(2):251-5
references.pmid: 10896917
references.citation: Colorectal Dis. 2011 Nov;13(11):e374-8
references.pmid: 21831098
references.citation: J Gastroenterol. 2012 Feb;47(2):127-35
references.pmid: 21983928
references.citation: N Engl J Med. 2012 Feb 23;366(8):687-96
references.pmid: 22356322
references.citation: N Engl J Med. 1993 Dec 30;329(27):1977-81
references.pmid: 8247072
references.citation: Gut. 2013 Feb;62(2):236-41
references.pmid: 22442161