Lake E S, Wadhwani S, Subar D, Kauser A, Harris C, Chang D, Lapsia S
East Lancashire Hospitals NHS Trust, UK.
Ann R Coll Surg Engl. 2014 Apr;96(3):211-5. doi: 10.1308/003588414X13814021679195.
The aim of this study was to evaluate the influence of flurodeoxyglucose positron emission tomography computed tomography (FDG PET-CT), as an adjunct to conventional CT staging, in the detection of extrahepatic disease in patients with potentially resectable colorectal liver metastasis.
Overall, 133 consecutive patients with colorectal liver metastases staged with CT and PET-CT referred to the East Lancashire regional hepatobiliary multidisciplinary team over a two-year period were included in this study. Abnormal findings on PET-CT were correlated with follow-up imaging and/or histology. All imaging was reviewed by specialist hepatobiliary radiologists for the presence/absence of extrahepatic disease. The influence of the PET-CT findings was categorised for each patient in relation to operability and other significant findings.
PET-CT had a major impact on staging of extra hepatic disease in 20% of patients, in comparison with the initial CT. Six per cent of patients were upstaged from operable CT findings to inoperable findings on PET-CT because of the discovery of inoperable occult extrahepatic disease. Five per cent had operable local regional nodal disease detected on PET-CT. A further 3% had premalignant colorectal lesions detected on PET-CT. Six per cent of patients were downstaged from indeterminate or suspected inoperable CT findings to operable findings on PET-CT.
The use of PET-CT in this setting may prevent futile operations, guide the resection of local regional nodal disease and downstage a number of patients thought to have extrahepatic disease on conventional imaging. This study has shown similar results to other recent studies and supports the use of PET-CT as a necessary staging modality in patients with potentially resectable colorectal liver metastases.
本研究旨在评估氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描（FDG PET-CT）作为传统CT分期的辅助手段，在检测潜在可切除的结直肠癌肝转移患者肝外疾病方面的影响。
本研究纳入了在两年期间转诊至东兰开夏郡地区肝胆多学科团队的133例经CT和PET-CT分期的连续结直肠癌肝转移患者。PET-CT上的异常发现与后续影像学检查和/或组织学结果相关。所有影像学检查均由专业肝胆放射科医生进行审查，以确定是否存在肝外疾病。根据手术可行性和其他重要发现，对每位患者PET-CT检查结果的影响进行分类。
与初始CT相比，PET-CT对20%的患者肝外疾病分期产生了重大影响。6%的患者因发现无法手术的隐匿性肝外疾病，从CT检查显示可手术转变为PET-CT检查显示不可手术。5%的患者在PET-CT上检测到可手术的局部区域淋巴结疾病。另外3%的患者在PET-CT上检测到结直肠癌前病变。6%的患者从CT检查显示不确定或疑似不可手术转变为PET-CT检查显示可手术。
在这种情况下使用PET-CT可以避免无意义手术，指导局部区域淋巴结疾病的切除，并使一些在传统影像学检查中被认为有肝外疾病的患者分期降低。本研究结果与其他近期研究相似，支持将PET-CT作为潜在可切除的结直肠癌肝转移患者必要的分期检查手段。
