Department of General Surgery, Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey.
Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
World J Surg. 2023 Oct;47(10):2532-2541. doi: 10.1007/s00268-023-07135-w. Epub 2023 Jul 30.
Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake.
Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions.
Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions.
Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.
结直肠癌是一个重大的全球健康问题，是全球第二大致命癌症和第三大常见癌症。早期发现和切除癌前病变对于预防癌症发展和降低死亡率至关重要。由于 FDG 摄取并不特异于恶性肿瘤，因此胃肠道中偶然发现的 FDG 摄取增加可能难以解释，可能需要进一步的结肠镜检查。本研究旨在探讨偶然发现的结直肠 FDG 摄取患者中与恶性和癌前病变相关的特征，并确定每个 FDG 摄取病例进行结肠镜检查的必要性。
对 2016 年 1 月至 2021 年 12 月期间接受结肠镜检查的患者数据进行回顾性分析。排除已知结直肠恶性肿瘤区域 FDG 摄取的患者。本研究纳入了 56 例偶然发现的结直肠 FDG 摄取患者。对 PET/CT 图像进行了视觉和定量分析，并记录了相应的结肠镜和组织病理学结果。进行了统计学分析，以评估 FDG 摄取模式、SUVmax 值和组织病理学诊断之间的关系。结肠镜检查结果分为恶性、息肉和非肿瘤性病变。
在 56 例偶然发现的结直肠 FDG 摄取患者中，共发现 36 个病灶，组织病理学显示 10 例（17.9%）患者存在恶性病变，26 例（46.4%）患者存在癌前息肉。FDG 摄取呈局灶性，伴有 CT 相应的壁增厚或软组织密度，与癌前或恶性病变的可能性更高相关。SUVmax 值在阴性发现与息肉/恶性之间存在显著差异。然而，恶性和癌前病变之间没有观察到显著差异。进行了 ROC 曲线分析，并评估了 SUVmax 值为 11.1 的截断值（敏感性：83.3%，特异性：90%），以区分癌前或恶性病变与非恶性病变。
偶然发现的结直肠 FDG 摄取呈局灶性模式且伴有相应 CT 表现，更可能提示癌前或恶性病变。SUVmax 值有助于预测病理发现，但组织病理学验证对于明确诊断仍然是必要的。这些发现有助于我们理解偶然发现的结直肠 FDG 摄取的临床意义，并强调了对进一步评估进行随访结肠镜检查的重要性。
