KOLOREKTAL KANSERLERİN EVRELEMESİNDE F-18 FDG PET/BT’NİN YERİ

Yıl 2016, Cilt: 38 Sayı: 3, 55 - 62, 24.09.2016

İnci Uslu Biner , İlknur Ak Sivrikoz Enver İhtiyar Zeki Üstüner Fezan Şahin

Öz

ÖZET:
Kolorektal
kanserli hastalarda flor-18 (18F)  florodeoksiglukoz (FDG) Pozitron Emisyon  Tomografisi /Bilgisayarlı Tomografi (PET/BT)   tanı ve evrelemedeki rolünün belirlenmesi Kolonoskopik biopsi ile kanıtlanmış
kolorektal kanser tanısı olan 44 hastada cerrahi
sonrası histopatolojik bulgular, biopsi (hepatik
metastazlarda) ve
yaygın uzak metastaz nedeniyle cerrahi yapılmayan hastalarda klinik ve
radyolojik takip bulguları altın standart kabul edilerek kontrastlı rutin
abdominopelvik bilgisayarlı tomografi (BT) ve 18F-FDG PET/BT bulguları karşılaştırıldı. Primer tümöral lezyonların tümünde
(%100) 18F-FDG PET/BT ile artmış metabolik aktivite izlendi. Lenf nodu
metastazını saptamada 18F-FDG PET/BT’nin duyarlılığı BT’ye göre daha düşük
(%35’e karşılık %60) oranda ancak özgüllüğü ve pozitif prediktif değeri (PPD)
BT’ye göre oldukça yüksek (%100’e karşılık %70.8 ve %100’e karşılık %63.2)
olarak saptandı. Yedi hepatik metastazlı hastanın hepsinde 18F-FDG PET/BT ile
lezyonlar hipermetabolik olarak görülmüş olup 18F-FDG PET/BT’nin karaciğer
metastazlarını saptamadaki duyarlılığı ve özgüllüğü %100 olarak saptandı. 7
hastanın ikisinde iğne biyopsisi ile karsinom metastazı gösterilirken bir
hastada operasyon sonrası yapılan metastazektomi ile tümör metastazı
bildirildi. Diğer 4 hastada ise karaciğerdeki lezyonlar beraberinde başka uzak
metastaz bulguları olması nedeniyle metastaz kabul edildi. BT’nin ise
duyarlılığı %71, özgüllüğü %74, doğruluğu %63.6, NPD’i %92, PPD’i %38 olarak
saptandı. 18F-FDG PET/BT ile 44 hastanın 17’inde (%38.6) ekstrahepatik uzak
metastaz (akciğer, kemik, sürrenal bezler ve supraklavikuler lenf nodu)
saptandı. Kolorektal kanserli hastaların ilk evrelemesinde 18F-FDG PET/BT’nin
tanısal BT’ye üstünlük göstermediği ve sınırlı bir tanısal değere sahip olduğu
görüldü. Çalışma sonuçlarımız bize 18F-FDG PET/BT’nin major rolünün hepatik ve
ekstrahepatik metastazların saptanması olduğunu ve tanı anında potansiyel
ekstrahepatik uzak metastazı olan ileri evre hastalarda 18F-FDG PET/BT’nin en
üstün görüntüleme yöntemi olduğunu düşündürmektedir.

ANAHTAR KELİMELER: Kolorektal kanser, 18 F-FDG PET/CT, CT, Evreleme.

THE ROLE OF F-18 FDG PET/CT IN STAGING OF COLORECTAL CANCERS

ABSTRACT: Setting the role of fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in detection of
the primary tumour and staging in colorectal cancer. Preoperative
Abdominopelvic CT and PET/CT findings of 44 patients that have colorectal
cancer histopathologically diagnosed by colonoscopic biopsy, were compared by
accepting postoperative histopathologic findings, biopsy (hepatic metastases)
and clinical and radiological follow-up of lesion progression in patients that
were not operated as gold standarts. All lesions were detected with F-18 FDG PET/CT
(%100) as all had incresed metabolic activity in F-18 FDG PET/CT
images.regarding detection of lymph node metastases, sensitivity of PET/BT was
lower(%35 vs %60) but specificity (%100 vs %70.8) and PPD (%100 vs%63.2) were
substantially higher than CT sensitivity. In all of the
seven patients with hepatic metastases, lesions were hipermetabolic on F-18 FDG
PET/CT images. Specificity and sensitivity of F-18 FDG PET/CT in detecting
hepatic metastases was %100. In two patients 
hepatic metastase was confirrmed 
by fine needle aspiration biopsy and by 
intraoperative metastasectomy in one. In rest four patientts the hepatic
FDG uptakes  were approved as  hepatic metastases since there were other
metastatic foci.Sensitivity of BT in detecting hepatic metastases was measured
as %71, spesifity is %74, accuracy is %63.6, NPD is %92, PPD is %38. 17
of 44 patients (%38.6) had extrahepatic distant metastases (lung, bone,
surrenal glands and supraclaviculer lymphnode).It was seen that F-18 FDG PET/CT
had limited diagnostic value at initial staging.of colorectal cancers. Our
results suggested that the major role of F-18 FDG PET/CT is detection of
hepatic and extrahepatic metastases and for advenced stage patients that have
potential to have extrahepatic metastases, 
F-18 FDG PET/CT  is the best
imaging modality.

KEYWORDS: Colorectal cancer, 18 F-FDG PET/CT, CT, Staging

 

Anahtar Kelimeler

Kolorektal kanser, 18 F-FDG PET/CT, CT

Kaynakça

• 1. Sayek İ. (1996). Kolorektal karsinomlar. Temel Cerrahi.1.Cilt Ankara: Güneş Kitabevi;.s 1169-1178.
• 2. Haznedar R. (2003). Kolorektal kanserler. İç:İliçin G., Biberoğlu K., Süleymanlar G., Ünal S., editörler. İç hastalıkları. Ankara: Güneş Kitabevi, s. 1604-1615.
• 3. Elmas N, Killi RM, Sever A (2002). Colorectal carcinoma: radiological diagnosis and staging.. Eur J Radiol. 42(3), 206-23.
• 4. Schöder, H., Larson, S. M., & Yeung, H. W. (2004). PET/CT in oncology: integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. Journal of Nuclear Medicine, 45( Suppl 1), 72-81.
• 5. Oğuz H, Yasasever V. (2004). Moleküler Tıpta Tümör Belirleyiciler. Türk Onkoloji Dergisi.; 19(1):28-36.
• 6. Menteş, BB., & Leventoğlu, S. (2004). Kolorektal Kanserlerin Klinik Özellikleri. Turkiye Klinikleri Journal of Surgery, 9(1), 36-38.
• 7. Abdel-Nabi, H., Doerr, R. J., Lamonica, D. M., Cronin, V. R., Galantowicz, P. J., Carbone, G. M., & Spaulding, M. B. (1998). Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology, 206(3), 755-760.
• 8. Kantorova, I., Lipská, L., Bêlohlávek, O., Visokai, V., Trubaĉ, M., & Schneiderová, M. (2003). Routine 18F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. Journal of Nuclear Medicine, 44(11), 1784-1788.
• 9. Masayamukai, SS., Yasuda, S., Hidekiishida, N., Tajima, T., & Makuuchi, H. (2000). Preoperative evaluation by whole-body 18F-fluorodeoxyglucose positron emission tomography in patients with primary colorectal cancer. Oncology reports, 7, 85-87.
• 10. Pelosi, E., & Deandreis, D. (2007). The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer. European Journal of Surgical Oncology (EJSO), 33(1), 1-6.
• 11. Akiyoshi, T., Oya, M., Fujimoto, Y., Kuroyanagi, H., Ueno, M., Yamaguchi, T., ... & Muto, T. (2009). Comparison of preoperative whole‐body positron emission tomography with MDCT in patients with primary colorectal cancer. Colorectal Disease, 11(5), 464-469.
• 12. Llamas-Elvira, J. M., Rodríguez-Fernández, A., Gutiérrez-Sáinz, J., Gomez-Rio, M., Bellon-Guardia, M., Ramos-Font, C., ... & Ferrón-Orihuela, A. (2007). Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer. European journal of nuclear medicine and molecular imaging, 34(6), 859-867.
• 13. Furukawa, H., Ikuma, H., Seki, A., Yokoe, K., Yuen, S., Aramaki, T., & Yamagushi, S. (2006). Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut, 55(7), 1007-1011.
• 14. Boykin KN, Zibari GB, Lilien DL, McMillan RW, Aultman DF, McDonald JC. (1999). The use of FDG-positron emission tomography for the evaluation of colorectal metastases of the liver. Am Surg.;65(12):1183-5.
• 15. Rohren, EM., Paulson, EK., Hagge, R., Wong, TZ., Killius, J., Clavien, PA., & Nelson, RC. (2002). The role of F-18 FDG positron emission tomography in preoperative assessment of the liver in patients being considered for curative resection of hepatic metastases from colorectal cancer.Clinical nuclear medicine, 27(8), 550-5.
• 16. Ogunbiyi, O. A., Flanagan, F. L., Dehdashti, F., Siegel, B. A., Trask, D. D., Birnbaum, E. H., ... & Kodner, I. J. (1997). Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and computed tomography. Annals of surgical oncology, 4(8), 613-620.
• 17. Berger, K. L., Nicholson, S. A., Dehdashti, F., & Siegel, B. A. (2000). FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. American Journal of Roentgenology, 174(4), 1005-1008.
• 18. Selzner, M., Hany, T. F., Wildbrett, P., McCormack, L., Kadry, Z., & Clavien, P. A. (2004). Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver?. Annals of surgery,240(6), 1027-1036.
• 19. Lake, E. S., Wadhwani, S., Subar, D., Kauser, A., Harris, C., Chang, D., & Lapsia, S. (2014). The influence of FDG PET-CT on the detection of extrahepatic disease in patients being considered for resection of colorectal liver metastasis. The Annals of The Royal College of Surgeons of England,96(3), 211-215.
• 20. Zubeldia, J. M., Bednarczyk, E. M., Baker, J. G., & Nabi, H. A. (2005). The economic impact of 18FDG positron emission tomography in the surgical management of colorectal cancer with hepatic metastases. Cancer biotherapy & radiopharmaceuticals, 20(4), 450-456.
• 21. Park, I. J., Kim, H. C., Yu, C. S., Ryu, M. H., Chang, H. M., Kim, J. H., ... & Kim, J. C. (2006). Efficacy of PET/CT in the accurate evaluation of primary colorectal carcinoma. European Journal of Surgical Oncology (EJSO), 32(9), 941-947.
• 22. Ruers, T. J. M., Langenhoff, B. S., Neeleman, N., Jager, G. J., Strijk, S., Wobbes, T. H., ... & Oyen, W. J. G. (2002). Value of positron emission tomography with [F-18] fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. Journal of Clinical Oncology, 20(2), 388-395.
• 23. Whiteford, M. H., Whiteford, H. M., Yee, L. F., Ogunbiyi, O. A., Dehdashti, F., Siegel, B. A., ... & Read, T. E. (2000). Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Diseases of the colon & rectum, 43(6), 759-767