Colorectal cancer patients before resection of hepatic metastases

 

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Summary

Aim: Evaluation of the role of FDG-PET in comparison to conventional staging methods for detecting extrahepatic tumour deposits prior to resection of liver metastases. Patients, Methods: In our prospective study, 58 patients (24 women, 34 men; age 33-81 years) with liver metastases of colorectal carcinoma underwent FDG-PET. Images were acquired in 3D-mode including transmission scans and reconstructed iteratively. For conventional staging all patients underwent abdominal ultrasound, helical computed tomography (CT) of the thorax and abdomen, and colonoscopy/rectoscopy. A preliminary therapeutic decision was established without knowledge of the FDG-PET findings. Thereafter, it was revised or confirmed according to the results of FDG-PET. Results: In 3/58 patients extrahepatic tumour deposits were concordantly identified with both conventional staging methods and FDG-PET. However, in one case, both conventional methods and FDG-PET were false positive regarding pulmonary metastases. In 12/58 patients, nothing but FDG-PET detected extrahepatic tumour masses, which were later confirmed either by histology or follow-up. Conclusion: Our study suggests that in 21% of patients exclusively FDG-PET is an appropriate diagnostic tool to reveal extrahepatic metastases or local recurrence of colorectal carcinoma. Our results demonstrate that FDG-PET provides relevant additional information for accurate therapeutic planning as compared to the conventional combination of staging methods. Therefore, FDG-PET has to exert a decisive influence on the decision for resection of hepatic metastases.

Zusammenfassung

Ziel: Bedeutung der FDG-PET zum Nachweis von extra-hepatischem Tumorgewebe vor Lebermetastasenresektion im Vergleich zum konventionellen Staging. Patienten, Methoden: In einer prospektiven Studie wurden 58 Patienten (24 Frauen, 34 Männer; Lebens-alter: 33-81 Jahre) mit Lebermetastasen eines Kolonoder Rektumkarzinoms untersucht. Die Ganzkörper-FDGPET erfolgte einschließlich Transmissionsmessung im 3D-Modus, die Rekonstruktion iterativ mit Schwächungskorrektur. Die Patienten erhielten zusätzlich im Rahmen der konventionellen Diagnostik Oberbauchsonographie, Spiral-Computertomographie und Rekto-/Koloskopie. Die Befundung der konventionellen Diagnostik und der PETUntersuchung erfolgte unabhängig voneinander. Basie-rend auf konventioneller Diagnostik wurde ohne Kenntnis des PET-Befundes eine vorläufige Entscheidung zur Resektion getroffen. Diese wurde je nach PET-Befund bestätigt oder geändert. Ergebnisse: Bei 3/58 Patienten wurde konventionell und mit FDG-PET übereinstimmend eine extrahepatische Metastasierung diagnostiziert. In einem Fall lieferten beide Verfahren falsch positive Ergebnisse hinsichtlich Lungenmetastasierung. Bei 12/58 Patienten wurde nur dank der FDG-PET-Untersuchung eine extrahepatische Metastasierung bzw. ein Lokalrezidiv histologisch gesichert oder im Verlauf nachgewiesen. Schlussfolgerung: Unsere Studie zeigt, dass bei 21% der Patienten ausschließlich die FDG-PET extra-hepatische Metastasen oder ein Lokalrezidiv bei kolorektalen Karzinomen nachweist. Im Vergleich zum konventionellen Staging liefert die FDG-PET relevante Zusatzinformationen und beeinflusst die Entscheidung zur Resektion von Lebermetastasen maßgeblich.

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