TY  - JOUR
T1  - EValuation of benign vs malignant hepatic lesions with positron emission tomography
AU  - Delbeke D, Martin WH, Sandler MP, Chapman WC, Wright, Jr J, Pinson C
Y1  - 1998/05/01
N1  - 10.1001/archsurg.133.5.510
JO  - Archives of Surgery
SP  - 510
EP  - 516
VL  - 133
IS  - 5
N2  - Background 
    In most malignant cells, the relatively low level of glucose-6-phosphatase leads to accumulation and trapping of [18F]fluorodeoxyglucose (FDG) intracellularly, allowing the visualization of increased uptake compared with normal cells.Objectives 
    To assess the value of FDG positron emission tomography (PET) to differentiate benign from malignant hepatic lesions and to determine in which types of hepatic tumors PET can help evaluate stage, monitor response to therapy, and detect recurrence.Design 
    Prospective blinded-comparison clinical cohort study.Setting 
    Tertiary care university hospital and clinic.Patients 
    One hundred ten consecutive referred patients with hepatic lesions 1 cm or larger on screening computed tomographic (CT) images who were seen for evaluation and potential resection underwent PET imaging. There were 60 men and 50 women with a mean (±SD) age of 59 ± 14 years. Follow-up was 100%.Interventions 
    A PET scan using static imaging was performed on all patients. The PET scan imaging and biopsy, surgery, or both were performed, providing pathological samples within 2 months of PET imaging. All PET images were correlated with CT scan to localize the lesion. However, PET investigators were unaware of any previous interpretation of the CT scan.Main Outcome Measures 
    Visual interpretation, lesion-to-normal liver background (L/B) ratio of radioactivity, and standard uptake value (SUV) were correlated with pathological diagnosis.Results 
    All (100%) liver metastases from adenocarcinoma and sarcoma primaries in 66 patients and all cholangiocarcinomas in 8 patients had increased uptake values, L/B ratios greater than 2, and an SUV greater than 3.5. Hepatocellular carcinoma had increased FDG uptake in 16 of 23 patients and poor uptake in 7 patients. All benign hepatic lesions (n = 23), including adenoma and fibronodular hyperplasia, had poor uptake, an L/B ratio of less than 2, and an SUV less than 3.5, except for 1 of 3 abscesses that had definite uptake.Conclusions 
    The PET technique using FDG static imaging was useful to differentiate malignant from benign lesions in the liver. Limitations include false-positive results in a minority of abscesses and false-negative results in a minority of hepatocellular carcinoma. The PET technique was useful in tumor staging and detection of recurrence, as well as monitoring response to therapy for all adenocarcinomas and sarcomas and most hepatocellular carcinomas. Therefore, pretherapy PET imaging is recommended to help assess new hepatic lesions.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.133.5.510
UR  - http://dx.doi.org/10.1001/archsurg.133.5.510
ER  -