Abstract
Purpose
In cases of obstructive colorectal cancer (CRC), preoperative diagnosis of the proximal lesion is often difficult when the primary lesion impedes the passage of the endoscope. The aim of this study was to evaluate the usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in such cases.
Materials and methods
A total of 52 obstructive CRC patients who underwent preoperative FDG-PET and subsequent surgical resection were retrospectively reviewed. The correlation between characteristics of the proximal lesion and FDG-PET findings was analyzed statistically.
Results
There was a significant correlation between the proximal lesion size and the maximum standardized uptake value (P = 0.00016). Abnormal FDG accumulation in the proximal colon indicated the existence of proximal cancer or adenoma with a sensitivity of 50% and a specificity of 100%. There was a significant difference in the distribution of tumor size between the cases with proximal abnormal accumulation and those with no proximal accumulation (P = 0.00014). A proximal tumor of ≥8 mm can be demonstrated by an accumulation of FDG with a sensitivity of 94.1%.
Conclusion
FDG-PET can estimate the existence of a proximal lesion and its size. Results may contribute to decisions regarding the type of surgery in cases of obstructive CRC.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Li M, Gu J. Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol 2005;11:4685–4688.
Oya M, Takahashi S, Okuyama T, Yamaguchi M, Ueda Y. Synchronous colorectal carcinoma: clinico-pathological features and prognosis. Jpn J Clin Oncol 2003;33:38–43.
Cunliffe WJ, Hasleton PS, Tweedle DE, Schofield PF. Incidence of synchronous and metachronous colorectal carcinoma. Br J Surg 1984;71:941–943.
Ekelund GR, Pihl B. Multiple carcinomas of the colon and rectum. Cancer 1974;33:1630–1634.
Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy and complications. Med Clin North Am 2002;86:1253–1288.
Pelosi E, Deandreis D. The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer. Eur J Surg Oncol 2007;33:1–6.
Crippa F, Gavazzi C, Bozzetti F, Chiesa C, Pascali C, Bogni A, et al. The influence of blood glucose levels on [18F]fluorodeoxyglucose (FDG) uptake in cancer: a PET study in liver metastases from colorectal carcinomas. Tumori 1997;83:748–752.
Brullet E, Montané JM, Bombardó J, Bonfill X, Noguè M, Bordas JM. Intraoperative colonoscopy in patients with colorectal cancer. Br J Surg 1992;79:1376–1378.
Kim MS, Park YJ. Detection and treatment of synchronous lesions in colorectal cancer: the clinical implication of perioperative colonoscopy. World J Gastroenterol 2007;13:4108–4111.
Koslin DB. Update on gastrointestinal imaging. Rev Gastroenterol Disord 2002;2:3–10.
Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130–160.
Liedenbaum MH, de Vries AH, van Rijn AF, Dekker HM, Willemssen FE, van Leerdam ME, et al. CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population. Abdom Imaging 2009 Nov 4. (Epub ahead of print)
Chaparro M, Gisbert JP, Del Campo L, Cantero J, Maté J. Accuracy of computed tomographic colonography for the detection of polyps and colorectal tumors: a systematic review and meta-analysis. Digestion 2009;80:1–17.
Endo K, Oriuchi N, Higuchi T, Iida Y, Hanaoka H, Miyakubo M, et al. PET and PET/CT using 18F-FDG in the diagnosis and management of cancer patients. Int J Clin Oncol 2006;11:286–296.
Nagata K, Ota Y, Okawa T, Endo S, Kudo S. PET/CT colonography for the preoperative evaluation of the colon proximal to the obstructive colorectal cancer. Dis Colon Rectum 2008;51:882–890.
Gu J, Yamamoto H, Fukunaga H, Danno K, Takemasa I, Ikeda M, et al. Correlation of GLUT-1 overexpression, tumor size, and depth of invasion with 18F-2-fluoro-2-deoxy-d-glucose uptake by positron emission tomography in colorectal cancer. Dig Dis Sci 2006;51:2198–2205.
Strauss LG, Klippel S, Pan L, Schönleben K, Haberkorn U, Dimitrakopoulou-Strauss A. Assessment of quantitative FDG PET data in primary colorectal tumours: which parameters are important with respect to tumour detection? Eur J Nucl Med Mol Imaging 2007;34:868–877.
Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. AJR Am J Roentgenol 2005;185:495–500.
Van Kouwen MC, Nagengast FM, Jansen JB, Oyen WJ, Drenth JP. 2-(18F)-fluoro-2-deoxy-d-glucose positron emission tomography detects clinical relevant adenomas of the colon: a prospective study. J Clin Oncol 2005;23:3713–3717.
Hebertson RA, Lee ST, Tebbutt N, Scott AM. The expanding role of PET technology in the management of patients with colorectal cancer. Ann Oncol 2007;18:1774–1781.
Engel H, Steinert H, Buck A, Berthold T, Huch Böni RA, von Schulthess GK. Whole-body PET: physiological and artifactual fluorodeoxyglucose accumulations. J Nucl Med 1996;37:441–446.
Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308–314.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Mori, S., Oguchi, K. Application of 18F-fluorodeoxyglucose positron emission tomography to detection of proximal lesions of obstructive colorectal cancer. Jpn J Radiol 28, 584–590 (2010). https://doi.org/10.1007/s11604-010-0477-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-010-0477-2