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The Quarterly Journal of Nuclear Medicine and Molecular imaging 2010 June;54(3):327-32

Copyright © 2010 EDIZIONI MINERVA MEDICA

lingua: Inglese

Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data

Smeets P. 1, Ham H. 2, Ceelen W. 3, Boterberg T. 4, Verstraete K. 1, Goethals I. 1

1 Department of Radiology, Ghent University Hospital, Ghent, Belgium; 2 Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium; 3 Department of Abdominal Surgery, Ghent University Hospital, Ghent, Belgium; 4 Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium


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AIM: The aim of this study was to evaluate the usefulness of visual and semiquantitative [18F]fluorodeoxy-glucose (FDG) positron emission tomography-computed tomography (PET-CT) data for the diagnosis of peri-anastomotic colorectal cancer recurrence, taking into account the time period between surgery and [18F]FDG PET-CT scanning.
METHODS: The study population consisted of 70 patients who had prior preoperative radiochemotherapy and surgical resection of the primary tumor and who underwent whole body [18F]FDG PET-CT scanning for the detection of recurrent disease. Visual and semiquantitative (SUVmax) analysis of [18F]FDG uptake at the peri-anastomosis was performed. The final diagnosis was based on pathological proof or clinical and/or imaging follow-up data.
RESULTS: On visual reading, 27 patients exhibited increased [18F]FDG uptake at the peri-anastomosis. Of these, 11 (41%) patients had a local tumor recurrence and 16 (59%) had no recurrent tumor. Among the 43 patients without increased [18F]FDG uptake at the peri-anastomosis, none had local tumor recurrence. On semiquantitation, SUVmax in patients with and without a local recurrence overlapped. However, when the time period between surgery and [18F]FDG PET-CT scanning was taken into account, overlap of SUVmax was mainly observed within a postoperative period of ≤12 months; thereafter, a threshold SUVmax of 3.2 discriminated between benign and malignant lesions in all but one patient.
CONCLUSION: In our series, visually increased [18F]FDG uptake at the peri-anastomosis was 100% sensitive but non-specific (73% specificity) for the diagnosis of local tumor recurrence. On the other hand, normal [18F]FDG uptake at the peri-anastomosis precluded a local tumor recurrence (a negative predictive value of 100%). In addition, semiquantitative (SUVmax) analysis of [18F]FDG uptake at the peri-anastomosis may increase specificity (up to 97%), while preserving maximum sensitivity, if the postoperative period is >12 months.

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