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The Role of Whole-Body Positron Emission Tomography With [18F]Fluorodeoxyglucose in Identifying Operable Colorectal Cancer Metastases to the Liver

David T. M. Lai, MBBS; Michael Fulham, MBBS, FRACP; Michael S. Stephen, MBBS, FRACS; Kent-Man Chu, MBBS, FRCS; Michael Solomon, MBBCh, BAO, FRACS; John F. Thompson, MBBS, FRACS; Donald M. Sheldon, MBBS, FRACS; David W. Storey, MBBS, FRCS, FRACS
Arch Surg. 1996;131(7):703-707. doi:10.1001/archsurg.1996.01430190025007.
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Objective:  To compare the accuracy of whole-body positron emission tomography (PET)using [18F]fluorodeoxyglucose (FDG) with conventional radiological imaging techniques in identifying operable colorectal cancer metastases to the liver.

Design:  A double-blind comparative study of FDG-PET as the criterion standard vs conventional radiological imaging methods as the criterion standard, in staging of recurrent colorectal cancer.

Setting:  Institutional practice in a tertiary referral center.

Patients:  Thirty-four consecutive patients with suspected colorectal cancer metastases, recruited for the study between May 1993 and October 1994.

Interventions:  Conventional radiological methods of cancer staging included abdominal computed tomography (CT) (n=34), chest x-rays (n=15), and chest CT (n=19) to evaluate extrahepatic disease. Twenty-seven patients were subsequently considered to have apparently isolated cancer metastases to the liver. Anatomical resectability was assessed by magnetic resonance imaging (n=24) or CT angiography (n=3) in all study patients. The FDG-PET studies (n=34) were performed within 8 weeks of conventional radiological imaging.

Main Outcome Measures:  Malignancy of suspected lesions detected by means of FDG-PET and conventional radiological imaging was confirmed by histopathologic examination of resected specimens and percutaneous biopsy specimens and by serial CT scans demonstrating progression of disease.

Results:  Unsuspected extrahepatic malignant disease that was missed by conventional radiological imaging was detected by FDG-PET in 11 patients (32%). The PET-detected extrahepatic malignant disease included retroperitoneal nodal metastases (n=6), pulmonary metastases (n=3), and locoregional cancer recurrences (n=2). The additional information afforded by PET consequently had an influence on the clinical management in 10 patients (29%).

Conclusion:  The FDG-PET method enabled selection of patients with apparently curable colorectal cancer metastases to the liver for hepatic resection.Arch Surg. 1996;131:703-707

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