Akhurst Tim, Gönen Mithat, Baser Raymond E, Schwartz Lawrence H, Tuorto Scott, Brody Lynn A, Covey Anne, Brown Karen T, Larson Steven M, Fong Yuman
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Peter MacCallum Cancer Centre, Victoria, Australia.
Hepatobiliary Surg Nutr. 2022 Aug;11(4):539-554. doi: 10.21037/hbsn-19-357.
Despite considerable advances in preoperative imaging, up to one-third of patients operatively explored for hepatic colorectal metastases are unexpectedly found to harbor unresectable intrahepatic or extrahepatic disease.
The current study is a prospective, blinded study comparing utility of [F]2-fluoro-2-deoxyglucose positron emission tomography (F-FDG-PET) to computed tomography (CT) and CT arterial portography (CTAP) as preoperative staging.
The 125 planned subjects were enrolled. Findings seen on FDG-PET alone changed therapy for 23 of 125 patients (18%). FDG-PET confirmed other radiologic findings in 16 cases (13%), for an overall influence on therapy in 39 cases (31%). FDG-PET was the most sensitive diagnostic imaging test for extrahepatic cancer; it was 80-90% sensitive for extrahepatic cancer and 70-90% specific. For the 28 cases of unresectable disease due to extrahepatic disease, FDG-PET findings solely changed therapies in 16 cases (57%) and influenced therapy in seven other cases (25%). Of the 21 unresectable cases due to extent of intrahepatic disease, FDG-PET did not solely change therapy in any. Overall, FDG-PET had the lowest sensitivity for hepatic sites compared with CT or CTAP. In particular, small (<1 cm) liver tumors were particularly poorly detected by FDG-PET. The area under the receiver operating characteristic (ROC) curve for small tumors was 0.58 and for patients on chemotherapy it was 0.66, a modest improvement over no imaging.
FDG-PET is an important test for preoperative staging of patients with hepatic colorectal metastases, affecting treatment decisions in nearly one-third of patients. The high yield is due mainly to detection of extrahepatic disease. It is therefore recommended in patients with extrahepatic lesions suspected to be disseminated cancer or those with high risk for extrahepatic disease. It is not a good test for identification of small tumors in the liver.
尽管术前影像学取得了显著进展，但在接受肝结直肠癌转移手术探查的患者中，高达三分之一的患者意外发现存在无法切除的肝内或肝外疾病。
本研究是一项前瞻性、盲法研究，比较[F]2-氟-2-脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）与计算机断层扫描（CT）及CT动脉门静脉造影（CTAP）作为术前分期的效用。
共纳入125名计划受试者。仅FDG-PET所见结果改变了125例患者中23例（18%）的治疗方案。FDG-PET在16例（13%）中证实了其他影像学检查结果，对39例（31%）患者的治疗产生了总体影响。FDG-PET是检测肝外癌最敏感的诊断性影像学检查；对肝外癌的敏感性为80%-90%，特异性为70%-90%。对于因肝外疾病导致无法切除的28例患者，FDG-PET结果仅改变了16例（57%）患者的治疗方案，并在另外7例（25%）患者中影响了治疗。在因肝内疾病范围导致无法切除的21例患者中，FDG-PET未单独改变任何一例患者的治疗方案。总体而言，与CT或CTAP相比，FDG-PET对肝脏部位的敏感性最低。特别是，FDG-PET对小（<1 cm）肝肿瘤的检测效果尤其不佳。小肿瘤的受试者操作特征（ROC）曲线下面积为0.58，接受化疗患者的ROC曲线下面积为0.66，相较于未进行影像学检查有适度改善。
FDG-PET是肝结直肠癌转移患者术前分期的重要检查，影响近三分之一患者的治疗决策。高检出率主要归因于肝外疾病的检测。因此，对于怀疑有肝外转移癌或肝外疾病风险高的肝外病变患者，建议进行该项检查。它不是检测肝脏小肿瘤的理想检查。
