The Impact of FDG-PET for the Preoperative Management of Patients with Colorectal Cancer

Objective: Whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) has proved effective in the diagnosis of recurrent colorectal cancer (CRC) and in the monitoring of cancer therapy. However there have been limited studies considering the effect of FDG-PET in the initial evaluation of CRC. We analysed how FDG-PET affects the management of patients with CRC preoperatively. Material and Methods: A prospective study of 26 consecutive patients with known or suspected CRC was undertaken. The patients were evaluated by computed tomography (CT) and FDG-PET. FDG-PET results were compared with those of CT and correlated with histopathologic findings or with clinical course. Results: FDG-PET had a sensitivity of 96% and positive predictive value of 100% for the diagnosis of primary cancer, while CT had values of 68% and 95%, respectively. FDG-PET was superior to CT in detecting additional metastatic disease with a sensitivity of 89%, while CT had 33%. FDG-PET resulted in altered management for 8 patients of whom three avoided inappropriate surgery. Conclusion: It is concluded that FDG-PET is highly sensitive for the diagnosis and staging of patients with CRC. Its use in conjunction with CT results in a more accurate selection of patients for surgical treatment with curative intent. Amac: Tum vucut fluorodeoksiglukoz pozitron emisyon tomografi (FDGPET) goruntulemenin rekurren kolorektal kanser (KRK) tanisindaki ve kanser tedavisine yanitin takibindeki rolu kanitlanmistir. Fakat KRKa#39;in FDGPET ile preoperatif degerlendirilmesinin tedavi secimine katkisi ile ilgili az sayida calisma mevcuttur. Bu calismada FDG-PETa#39;in KRKa#39;li hastalarda, preoperatif donemde, hasta yonetimine katkisini arastirdik. Gerec ve Yontemler: Bu prospektif calismaya, histopatolojik veya yuksek klinik suphe ile KRK tanisi almis, 26 ardisik hasta (16 erkek, 10 kadin) dahil edildi. Tum hastalar bilgisayarli tomografi (BT) ve FDG-PET ile degerlendirildi. Histopatolojik veya klinik takip bulgulari esas alinarak FDG-PET sonuclari BT sonuclari ile karsilastirildi. Bulgular: FDG-PET primer kanseri saptamada %96 duyarliliga ve %100 pozitif ongoru degerine sahipken BTa#39;de bu degerler sirasiyla %68 ve %95 idi. FDG-PET ilave metastatik hastaligi saptamada %89 duyarlilik ile BTa#39;ye (%33) ustunluk gostermekteydi. FDG-PET 8 hastanin tedavi seciminde degisiklige neden olarak olumlu katki yapti, bunlardan 3a#39;unde gereksiz cerrahiden kacinilmis oldu. Sonuc: FDG-PETa#39;in KRKa#39;in tanisinda ve evrelemesinde yuksek duyarlilik gosterdigi sonucuna varilmistir. BT ile birlikte kullanimi kuratif amacli cerrahi islem planlanan hastalarin daha dogru sekilde secilmelerine olanak saglar.