Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;11(4):539-554.
doi: 10.21037/hbsn-19-357.

Prospective evaluation of 18F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases

Tim Akhurst  1   2 , Mithat Gönen  3 , Raymond E Baser  3 , Lawrence H Schwartz  1 , Scott Tuorto  4 , Lynn A Brody  1 , Anne Covey  1 , Karen T Brown  1 , Steven M Larson  1 , Yuman Fong  4
Affiliations

Prospective evaluation of 18F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases

Tim Akhurst et al. Hepatobiliary Surg Nutr. 2022 Aug.

Abstract

Background: Despite considerable advances in preoperative imaging, up to one-third of patients operatively explored for hepatic colorectal metastases are unexpectedly found to harbor unresectable intrahepatic or extrahepatic disease.

Methods: The current study is a prospective, blinded study comparing utility of [18F]2-fluoro-2-deoxyglucose positron emission tomography (18F-FDG-PET) to computed tomography (CT) and CT arterial portography (CTAP) as preoperative staging.

Results: The 125 planned subjects were enrolled. Findings seen on FDG-PET alone changed therapy for 23 of 125 patients (18%). FDG-PET confirmed other radiologic findings in 16 cases (13%), for an overall influence on therapy in 39 cases (31%). FDG-PET was the most sensitive diagnostic imaging test for extrahepatic cancer; it was 80-90% sensitive for extrahepatic cancer and 70-90% specific. For the 28 cases of unresectable disease due to extrahepatic disease, FDG-PET findings solely changed therapies in 16 cases (57%) and influenced therapy in seven other cases (25%). Of the 21 unresectable cases due to extent of intrahepatic disease, FDG-PET did not solely change therapy in any. Overall, FDG-PET had the lowest sensitivity for hepatic sites compared with CT or CTAP. In particular, small (<1 cm) liver tumors were particularly poorly detected by FDG-PET. The area under the receiver operating characteristic (ROC) curve for small tumors was 0.58 and for patients on chemotherapy it was 0.66, a modest improvement over no imaging.

Conclusions: FDG-PET is an important test for preoperative staging of patients with hepatic colorectal metastases, affecting treatment decisions in nearly one-third of patients. The high yield is due mainly to detection of extrahepatic disease. It is therefore recommended in patients with extrahepatic lesions suspected to be disseminated cancer or those with high risk for extrahepatic disease. It is not a good test for identification of small tumors in the liver.

Keywords: Positron emission tomography (PET); colorectal; computed tomography (CT); hepatic; metastases; surgery.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-19-357/coif). YF serves as an unpaid editorial board member of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Influence of FDG-PET scanning on entire cohort of 125 patients being evaluated by imaging prior to attempted resection for colorectal metastases. FDG-PET, [18F]2-fluoro-2-deoxyglucose positron emission tomography.
Figure 2
Figure 2
Incidence of extrahepatic disease as related to CRS. CRS, clinical risk score.
Figure 3
Figure 3
ROC curves for CT, CTAP, and FDG-PET for hepatic metastases from colorectal cancers. CT, computed tomography; CTAP, CT arterial portography; FDG-PET, [18F]2-fluoro-2-deoxyglucose positron emission tomography; ROC, receiver operating characteristic.
Figure 4
Figure 4
ROC curves for the imaging modalities according to size of liver metastases. CT, computed tomography; CTAP, CT arterial portography; PET, positron emission tomography; ROC, receiver operating characteristic.
Figure 5
Figure 5
ROC curves for the various modalities according to immediate exposure to chemotherapy. CT, computed tomography; CTAP, CT arterial portography; PET, positron emission tomography; ROC, receiver operating characteristic.
See this image and copyright information in PMC

References

    1. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309-18; discussion 318-21. 10.1097/00000658-199909000-00004 - DOI - PMC - PubMed
    1. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002;235:759-66. 10.1097/00000658-200206000-00002 - DOI - PMC - PubMed
    1. Kato T, Yasui K, Hirai T, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum 2003;46:S22-31. - PubMed
    1. Fernandez FG, Drebin JA, Linehan DC, et al. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004;240:438-47; discussion 447-50. 10.1097/01.sla.0000138076.72547.b1 - DOI - PMC - PubMed
    1. Stewart CL, Warner S, Ito K, et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018;55:330-79. 10.1067/j.cpsurg.2018.08.004 - DOI - PMC - PubMed