Department of Radiology, The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.
Cancer Biomark. 2010;7(4):235-48. doi: 10.3233/CBM-2010-0201.
Growing subsets of patients with metastatic colorectal cancer (CRC) are being considered for treatment with curative intent. Accurate restaging of patients with potentially resectable hepatic or pulmonary metastases is therefore crucial for optimal management. This article presents data to assess the role of 18-fluoro-deoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT) in metastatic CRC.
A total of 341 patients with potentially resectable liver and/or pulmonary CRC metastases underwent (18)FDG PET/CT between 1st April 2007 and 31st August 2008 at our unit. Of these, 157 patients fulfilled the inclusion criteria and were included in this retrospective assessment. Imaging and clinical histories of these patients were evaluated. Findings on PET/CT were compared with pre-PET/CT conventional imaging and overall impact on patient management was assessed. The PET/CT results were confirmed either with histological comparison where available or with serial imaging follow up.
On a lesion to lesion basis, PET/CT when compared with pre-PET/CT conventional imaging in patients with metastatic liver and lung lesions had a Spearman correlation coefficient of 0.8 and P value < 0.0001 in both subgroups. PET/CT upstaged disease in 33.1% (52/157), down staged disease in 24.9% (39/157) and was in agreement with pre-PET/CT conventional imaging in the remaining 42% of patients (66/157). Based on PET/CT results surgery was averted in 33.8% patients (53/157). PET/CT had a sensitivity of 87.1%, specificity of 88.0%, positive predictive value of 97.4%, negative predictive value of 56.4% and an overall accuracy of 87.3% in assessing metastatic disease.
Assessment with (18)FDG PET/CT has a significant impact on the management of CRC patients with hepatic and pulmonary metastases.
越来越多的转移性结直肠癌（CRC）患者被认为可以采用治愈性治疗。因此，准确分期潜在可切除肝或肺转移灶对于优化管理至关重要。本文介绍了评估 18-氟-脱氧葡萄糖（18）FDG 正电子发射断层扫描/计算机断层扫描（PET/CT）在转移性 CRC 中的作用的数据。
2007 年 4 月 1 日至 2008 年 8 月 31 日，我们单位共有 341 例肝和/或肺 CRC 转移灶有潜在可切除性的患者接受了 18FDG PET/CT 检查。其中，157 例患者符合纳入标准并纳入本回顾性评估。评估了这些患者的影像学和临床病史。比较了 PET/CT 与 PET/CT 前常规影像学的结果，并评估了对患者管理的总体影响。PET/CT 结果通过有组织学比较的可用结果或通过连续影像学随访进行证实。
在有肝和肺转移灶的患者中，PET/CT 与 PET/CT 前常规影像学比较，Spearman 相关系数在两组中分别为 0.8 和 P 值均＜0.0001。PET/CT 使 33.1%（52/157）患者的疾病分期升高，24.9%（39/157）患者的疾病分期降低，其余 42%（66/157）患者的疾病分期与 PET/CT 前常规影像学一致。基于 PET/CT 结果，有 33.8%的患者（53/157）避免了手术。PET/CT 对评估转移性疾病的敏感性为 87.1%，特异性为 88.0%，阳性预测值为 97.4%，阴性预测值为 56.4%，总准确性为 87.3%。
18FDG PET/CT 评估对有肝和肺转移灶的 CRC 患者的管理有重大影响。
