Aymard Samuel, Rust Edmond, Kaseb Ashjan, Liu David, Hubele Fabrice, Romain Benoit, Averous Gerlinde, Brigand Cecile, Imperiale Alessio
Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67033 Strasbourg, France.
Nuclear Medicine, Fondation de la Maison du Diaconat, 68200 Mulhouse, France.
Cancers (Basel). 2024 Jan 4;16(1):233. doi: 10.3390/cancers16010233.
We analyzed whether preoperative F-FDG PET/CT adds to conventional primary staging in patients with presumed non-metastatic colonic cancer (CC). The prognostic role of F-FDG uptake in the primary tumor was evaluated after a mean follow-up of 15 years. Patients with a new diagnosis of presumed localized CC were prospectively enrolled and underwent presurgical F-FDG PET/CT. For each colon lesion, SUVmax, SUVpeak, TLG, and MTV were assessed and tested as prognostic factors. Forty-eight patients were included. Post-surgery pathology identified a total of 103 colon lesions, including 58 invasive adenocarcinomas, 4 in situ adenocarcinomas, 3 adenomas with high-grade dysplasia, and 38 adenomas with low-grade dysplasia. Per lesion sensitivity, specificity, positive (PPVs) and negative predictive values (NPVs) for colonic primary tumor detection were 78%, 97%, 98%, and 73% for conventional workup, and 94%, 87%, 92%, and 89% for F-FDG PET/CT. Only sensitivity was significantly different between F-FDG PET/CT and conventional workup. PET detected an additional ten pathological colonic lesions in seven patients. SUVmax, SUVpeak, and TLG showed significant differences between invasive adenocarcinomas, in situ adenocarcinomas, and high-grade dysplasia compared to low-grade dysplasia. There was a statistically significant difference between pT1-pT2 and pT3-pT4 adenocarcinomas. On patient-based analysis, sensitivity, specificity, PPV, and NPV for nodal staging were 22%, 84%, 44%, and 65% for CECT, and 33%, 90%, 67%, and 70% for F-FDG PET/CT, without a statistically significant difference. PET/CT also identified unknown metastatic spread and one synchronous lung cancer in four patients. Overall, F-FDG PETCT had an additional diagnostic value in 11 out of 48 patients (23%). F-FDG uptake of the primary tumor did not predict nodal or distant metastases. The difference in disease-free survival categorized by median SUVmax, SUVpeak, TLG, and MTV was not significant. Finally, preoperative F-FDG PET/CT is valuable in detecting potential colon lesions not visualized by conventional workups, especially in cases of incomplete colonoscopy. It effectively highlights distant metastases but exhibits limitations for N staging. Mainly due to the relatively small sample size, the quantitative analysis of F-FDG uptake in the primary tumor did not reveal any association with recurrence or disease-free survival, adding no significant prognostic information.
我们分析了术前F-FDG PET/CT是否能为疑似非转移性结肠癌（CC）患者的传统初步分期提供更多信息。在平均随访15年后，评估了原发肿瘤中F-FDG摄取的预后作用。对新诊断为疑似局限性CC的患者进行前瞻性登记，并在术前接受F-FDG PET/CT检查。对每个结肠病变评估SUVmax、SUVpeak、TLG和MTV，并将其作为预后因素进行测试。纳入了48例患者。术后病理共鉴定出103个结肠病变，包括58例浸润性腺癌、4例原位腺癌、3例高级别异型增生腺瘤和38例低级别异型增生腺瘤。对于结肠原发肿瘤检测，传统检查的每病变敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为78%、97%、98%和73%，F-FDG PET/CT分别为94%、87%、92%和89%。F-FDG PET/CT与传统检查之间仅敏感性有显著差异。PET在7例患者中额外检测到10个病理性结肠病变。与低级别异型增生相比，浸润性腺癌、原位腺癌和高级别异型增生的SUVmax、SUVpeak和TLG有显著差异。pT1-pT2和pT3-pT4腺癌之间存在统计学显著差异。基于患者的分析中，CECT的淋巴结分期敏感性、特异性、PPV和NPV分别为22%、84%、44%和65%，F-FDG PET/CT分别为33%、90%、67%和70%，无统计学显著差异。PET/CT还在4例患者中发现了未知的转移扩散和1例同步性肺癌。总体而言，F-FDG PETCT在48例患者中有11例（23%）具有额外的诊断价值。原发肿瘤的F-FDG摄取不能预测淋巴结或远处转移。按SUVmax、SUVpeak、TLG和MTV中位数分类的无病生存期差异不显著。最后，术前F-FDG PET/CT在检测传统检查未发现的潜在结肠病变方面有价值，尤其是在结肠镜检查不完全的情况下。它能有效突出远处转移，但在N分期方面存在局限性。主要由于样本量相对较小，原发肿瘤中F-FDG摄取的定量分析未显示与复发或无病生存期有任何关联，未增加显著的预后信息。
