Öz
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. Amaç: Tüm vücut fluorodeoksiglukoz pozitron emisyon tomografi (FDGPET) görüntülemenin rekürren kolorektal kanser (KRK) tanısındaki ve kanser tedavisine yanıtın takibindeki rolü kanıtlanmıştır. Fakat KRK'in FDGPET ile preoperatif değerlendirilmesinin tedavi seçimine katkısı ile ilgili az sayıda çalışma mevcuttur. Bu çalışmada FDG-PET'in KRK'li hastalarda, preoperatif dönemde, hasta yönetimine katkısını araştırdık. Gereç ve Yöntemler: Bu prospektif çalışmaya, histopatolojik veya yüksek klinik şüphe ile KRK tanısı almış, 26 ardışık hasta (16 erkek, 10 kadın) dahil edildi. Tüm hastalar bilgisayarlı tomografi (BT) ve FDG-PET ile değerlendirildi. Histopatolojik veya klinik takip bulguları esas alınarak FDG-PET sonuçları BT sonuçları ile karşılaştırıldı. Bulgular: FDG-PET primer kanseri saptamada %96 duyarlılığa ve %100 pozitif öngörü değerine sahipken BT'de bu değerler sırasıyla %68 ve %95 idi. FDG-PET ilave metastatik hastalığı saptamada %89 duyarlılık ile BT'ye (%33) üstünlük göstermekteydi. FDG-PET 8 hastanın tedavi seçiminde değişikliğe neden olarak olumlu katkı yaptı, bunlardan 3'ünde gereksiz cerrahiden kaçınılmış oldu. Sonuç: FDG-PET'in KRK'in tanısında ve evrelemesinde yüksek duyarlılık gösterdiği sonucuna varılmıştır. BT ile birlikte kullanımı küratif amaçlı cerrahi işlem planlanan hastaların daha doğru şekilde seçilmelerine olanak sağlar.
Anahtar Kelimeler
Kaynakça
- Llamas-Elvira JM, Rodriquez-Fernandez A, Gutierrez-Sainz J, Go- mez-Rio M, Bellon-Guaria M, Ramos-Font C, et al. Fluorine- 18 fl uorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging 2007;34:859-67. [CrossRef]
- Heriot A, Kumar D. Rectal cancer recurrence: factors and mecha- nisms. Colorectal Dis 2000;2:126-36. [CrossRef]
- Cohen AM. Preoperative evaluation of patients with primary colorectal cancer. Cancer 1992;70:1328-32. [CrossRef]
- Grabbe E, Winkler R. Local recurrence after sphincter saving re- section for rectal and rectosigmoid carcinoma. Value of various diagnostic methods. Radiology 1985;155:305-10.
- Chen YM, Ott DJ, Wollfman NT, Gelfand DW, Karsteadt N, Bechtold RE. Recurrent colorectal carcinoma: evaluation with barium enema examination and CT. Radiology 1987;163:307-10.
- Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993;270:943-7. [CrossRef]
- Meta J, Seltzer M, Schiepers C, Silverman DH, Ariannejad M, Gambhir SS, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician’s perspective. J Nucl Med 2001;42:586-90.
- Kalff V, Hicks RJ, Ware RE, Hogg A, Binns D, McKenzie AF. The clinical impact of 18F-FDG PET in patients with suspected or conŞ rmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492-9.
- Fukunaga H, Sekimoto M, Ikeda M, Higuchi I, Yasui M, Seshimo I, et al. Fusion image of positron emission tomography and com- puted tomography for the diagnosis of local recurrence of rectal cancer. Ann Surg Oncol 2005;12:561-9. [CrossRef]
- Selzner M, Hany TF, Wildbrett P, McCormack L, Kadry Z, Clavien PA. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg 2004;240:1027-34. [CrossRef]
- Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Survival of patients evaluated by FDG-PET before hepatic resec- tion for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001;233:293-9. [CrossRef]
- Abdel-Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantow- icz PJ, Carbone GM, et al. Staging of primary colorectal carci- nomas with Fluorine-18-fl uorodeoxyglucose whole-body PET: correlation with histopathologic and CT Ş ndings. Radiology 1998;206:755-60.
- Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG-PET detection of recurrent colorectal cancer. J Nucl Med 2000;41:1177-89.
- Ruers TJ, LAngenhoff BS, Neeleman N, Jarger GJ, Strijk S, Wobbes T, et al. Value of positron emission tomography with [F- 18] fl uorodeoxyglucose in patients with colorectal liver metasta- ses: a prospective study. J Clin Oncol 2002;20:388-95. [CrossRef]
- Ogunbiyi OA, Flanagan FL, Dehdashti F, Siegel BA, Trask DD, Birn- baum EH, et al. Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and comput- ed tomography. Ann Surg Oncol 1997;4:613-20. [CrossRef]
- Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol 1991;9:1105-12.
- Jerusalem G, Beguin Y, Fassotte MF, Najjar F, Paulus P, Rigo P, et al. Whole-body positron emission tomography using 18-F- Fluorodeoxyglucose for post-treatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical conventional tomography scan imaging. Blood 1999;94:429-33. [CrossRef]
- Geoghegan JG, Scheele J. Treatment of colorectal liver metasta- ses. Br J Surg 1999;86:158-69. [CrossRef]
- Jarnagin WR, Fong Y, Ky A, Schwartz LH, Paty PB, Cohen AM, et al. Liver resection for metastatic colorectal cancer: assessing the risk of oc- cult irresectable disease. J Am Coll Surg 1999;188:33-42. [CrossRef]
- Flamen P, Stroobants S, Van Cutsem E, Dupont P, Bormans G, De Vadder N, et al. Additional value of whole body positron emis- sion tomography with fl uorine-18-2-fl ouro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 1999;17:894-901.
- Delbeke D, Vitola JW, Sandler MP, Arildsen RC, Powers TA, Wright JK Jr, et al. Staging recurrent metastatic colorectal carci- noma with PET. J Nucl Med 1997;38:1196-201.
Öz
Amaç: Tüm vücut fluorodeoksiglukoz pozitron emisyon tomografi (FDGPET)
görüntülemenin rekürren kolorektal kanser (KRK) tanısındaki ve kanser
tedavisine yanıtın takibindeki rolü kanıtlanmıştır. Fakat KRK’in FDGPET
ile preoperatif değerlendirilmesinin tedavi seçimine katkısı ile ilgili
az sayıda çalışma mevcuttur. Bu çalışmada FDG-PET’in KRK’li hastalarda,
preoperatif dönemde, hasta yönetimine katkısını araştırdık.
Gereç ve Yöntemler: Bu prospektif çalışmaya, histopatolojik veya yüksek
klinik şüphe ile KRK tanısı almış, 26 ardışık hasta (16 erkek, 10 kadın)
dahil edildi. Tüm hastalar bilgisayarlı tomografi (BT) ve FDG-PET ile
değerlendirildi. Histopatolojik veya klinik takip bulguları esas alınarak
FDG-PET sonuçları BT sonuçları ile karşılaştırıldı.
Bulgular: FDG-PET primer kanseri saptamada %96 duyarlılığa ve %100
pozitif öngörü değerine sahipken BT’de bu değerler sırasıyla %68 ve %95
idi. FDG-PET ilave metastatik hastalığı saptamada %89 duyarlılık ile BT’ye
(%33) üstünlük göstermekteydi. FDG-PET 8 hastanın tedavi seçiminde
değişikliğe neden olarak olumlu katkı yaptı, bunlardan 3’ünde gereksiz
cerrahiden kaçınılmış oldu.
Sonuç: FDG-PET’in KRK’in tanısında ve evrelemesinde yüksek duyarlılık
gösterdiği sonucuna varılmıştır. BT ile birlikte kullanımı küratif amaçlı cerrahi
işlem planlanan hastaların daha doğru şekilde seçilmelerine olanak
sağlar.
Anahtar Kelimeler
Kaynakça
- Llamas-Elvira JM, Rodriquez-Fernandez A, Gutierrez-Sainz J, Go- mez-Rio M, Bellon-Guaria M, Ramos-Font C, et al. Fluorine- 18 fl uorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging 2007;34:859-67. [CrossRef]
- Heriot A, Kumar D. Rectal cancer recurrence: factors and mecha- nisms. Colorectal Dis 2000;2:126-36. [CrossRef]
- Cohen AM. Preoperative evaluation of patients with primary colorectal cancer. Cancer 1992;70:1328-32. [CrossRef]
- Grabbe E, Winkler R. Local recurrence after sphincter saving re- section for rectal and rectosigmoid carcinoma. Value of various diagnostic methods. Radiology 1985;155:305-10.
- Chen YM, Ott DJ, Wollfman NT, Gelfand DW, Karsteadt N, Bechtold RE. Recurrent colorectal carcinoma: evaluation with barium enema examination and CT. Radiology 1987;163:307-10.
- Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993;270:943-7. [CrossRef]
- Meta J, Seltzer M, Schiepers C, Silverman DH, Ariannejad M, Gambhir SS, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician’s perspective. J Nucl Med 2001;42:586-90.
- Kalff V, Hicks RJ, Ware RE, Hogg A, Binns D, McKenzie AF. The clinical impact of 18F-FDG PET in patients with suspected or conŞ rmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492-9.
- Fukunaga H, Sekimoto M, Ikeda M, Higuchi I, Yasui M, Seshimo I, et al. Fusion image of positron emission tomography and com- puted tomography for the diagnosis of local recurrence of rectal cancer. Ann Surg Oncol 2005;12:561-9. [CrossRef]
- Selzner M, Hany TF, Wildbrett P, McCormack L, Kadry Z, Clavien PA. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg 2004;240:1027-34. [CrossRef]
- Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Survival of patients evaluated by FDG-PET before hepatic resec- tion for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001;233:293-9. [CrossRef]
- Abdel-Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantow- icz PJ, Carbone GM, et al. Staging of primary colorectal carci- nomas with Fluorine-18-fl uorodeoxyglucose whole-body PET: correlation with histopathologic and CT Ş ndings. Radiology 1998;206:755-60.
- Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG-PET detection of recurrent colorectal cancer. J Nucl Med 2000;41:1177-89.
- Ruers TJ, LAngenhoff BS, Neeleman N, Jarger GJ, Strijk S, Wobbes T, et al. Value of positron emission tomography with [F- 18] fl uorodeoxyglucose in patients with colorectal liver metasta- ses: a prospective study. J Clin Oncol 2002;20:388-95. [CrossRef]
- Ogunbiyi OA, Flanagan FL, Dehdashti F, Siegel BA, Trask DD, Birn- baum EH, et al. Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and comput- ed tomography. Ann Surg Oncol 1997;4:613-20. [CrossRef]
- Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol 1991;9:1105-12.
- Jerusalem G, Beguin Y, Fassotte MF, Najjar F, Paulus P, Rigo P, et al. Whole-body positron emission tomography using 18-F- Fluorodeoxyglucose for post-treatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical conventional tomography scan imaging. Blood 1999;94:429-33. [CrossRef]
- Geoghegan JG, Scheele J. Treatment of colorectal liver metasta- ses. Br J Surg 1999;86:158-69. [CrossRef]
- Jarnagin WR, Fong Y, Ky A, Schwartz LH, Paty PB, Cohen AM, et al. Liver resection for metastatic colorectal cancer: assessing the risk of oc- cult irresectable disease. J Am Coll Surg 1999;188:33-42. [CrossRef]
- Flamen P, Stroobants S, Van Cutsem E, Dupont P, Bormans G, De Vadder N, et al. Additional value of whole body positron emis- sion tomography with fl uorine-18-2-fl ouro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 1999;17:894-901.
- Delbeke D, Vitola JW, Sandler MP, Arildsen RC, Powers TA, Wright JK Jr, et al. Staging recurrent metastatic colorectal carci- noma with PET. J Nucl Med 1997;38:1196-201.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Şubat 2011 |
| Yayımlandığı Sayı | Yıl 2011 Cilt: 2011 Sayı: 2 |