Surgical Research Department, Regional Hospital West, Herning, Denmark.
Department of Nuclear Medicine, Regional Hospital West, Herning, Denmark.
Scand J Gastroenterol. 2022 Feb;57(2):246-252. doi: 10.1080/00365521.2021.1998602. Epub 2021 Nov 4.
The primary aim of this study was to evaluate the correlation between incidental focal colorectal foci on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) with colonoscopic and histopathological results. The secondary aim was to determine to what extent these findings led to a change in patient management.
A retrospective study was performed among 5850 patients who had an FDG-PT/CT scan from July 2015 to July 2018. Among these patients, we identified patients with a PET/CT description of incidental colorectal FDG uptake, and a colonoscopy within 90 days from the PET/CT scan. PET/CT findings were compared with colonoscopy-detected lesions and eventually histopathology on a per-lesion analysis and a per-person analysis.
A total of 145 patients were included in the study. A total of 180 foci of colorectal FDG uptake were detected on FDG-PET/CT. Of these, 86 foci corresponded to advanced colorectal neoplasia (ACRN), positive predictive value (PPV) 47.8%; 95% CI: 40.5-55.1%). On a per-patient analysis 81 patients had a least one ACRN at colonoscopy (PPV 55.9%; 95% CI: 47.6-63.8), this group included 20 patients (13.8%) diagnosed with cancer. There was a small positive correlation between focal FDG-uptake and the finding of ACRN at the same colonic segment at colonoscopy, which was statistically significant, rho = 0.2565, = .002. The findings changed patient management in 67 (46.2%) cases.
Incidental focal colorectal FDG uptake on PET/CT is associated with a high risk of ACRN and is affecting subsequent patient management. Further evaluation with colonoscopy is recommended when the patient is considered suitable for further treatment.
本研究的主要目的是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）上偶然发现的结直肠焦点与结肠镜和组织病理学结果之间的相关性。次要目的是确定这些发现在多大程度上导致了患者管理的改变。
对 2015 年 7 月至 2018 年 7 月间进行 FDG-PT/CT 扫描的 5850 例患者进行了回顾性研究。在这些患者中，我们确定了 PET/CT 描述为偶然发现的结直肠 FDG 摄取且在 PET/CT 扫描后 90 天内进行结肠镜检查的患者。对每处病变和每例患者进行 PET/CT 检查结果与结肠镜检查发现的病变和最终组织病理学检查结果进行比较。
共有 145 例患者纳入研究。FDG-PET/CT 上共检测到 180 个结直肠 FDG 摄取焦点。其中，86 个焦点对应高级结直肠肿瘤（ACRN），阳性预测值（PPV）为 47.8%；95%可信区间：40.5-55.1%）。在每例患者的分析中，81 例患者在结肠镜检查时至少有一个 ACRN（PPV 55.9%；95%可信区间：47.6-63.8%），其中包括 20 例（13.8%）诊断为癌症的患者。在同一结肠段，焦点 FDG 摄取与结肠镜检查时发现 ACRN 之间存在小的正相关，具有统计学意义，rho = 0.2565，= 0.002。这些发现改变了 67 例（46.2%）患者的治疗方案。
PET/CT 上偶然发现的结直肠焦点摄取与 ACRN 风险高相关，并影响后续的患者管理。当患者被认为适合进一步治疗时，建议进一步进行结肠镜检查评估。
