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Clinical significance of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in the follow-up of colorectal cancer: searching off approaches increasing specificity for detection of recurrence

Semra Ince
Semra Ince
, 
Kursat Okuyucu
Kursat Okuyucu
, 
Oguz Hancerliogulları
Oguz Hancerliogulları
, 
Engin Alagoz
Engin Alagoz
, 
Huseyin San
Huseyin San
 and 
Nuri Arslan
Nuri Arslan
   | Nov 01, 2017
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Article Category: Research Article
Published Online: Nov 01, 2017
Page range: 378 - 385
Received: Jul 19, 2017
Accepted: Sep 10, 2017
DOI: https://doi.org/10.1515/raon-2017-0045
© 2017 Semra Ince, Kursat Okuyucu, Oguz Hancerliogulları, Engin Alagoz, Huseyin San, Nuri Arslan
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Box-plot graph illustrating the distribution of SUVmax through benign conditions and disease recurrence.
Box-plot graph illustrating the distribution of SUVmax through benign conditions and disease recurrence.

Figure 2

ROC curve drawn to indicate the detection and diagnostic accuracy of SUVmax in recurrence/metastasis.
ROC curve drawn to indicate the detection and diagnostic accuracy of SUVmax in recurrence/metastasis.

Figure 3

A female patient aged 51 years with rectum cancer was operated and treated by chemoradiotherapy. MRI findings revealed suspected metastasis with serum CEA and Ca 19-9 in normal range during the follow-up. Her axial PET (A), CT (B), fusion (C) and coronal PET (D), CT (E), fusion (F) images on 18F-FDG-PET/CT showed a focal uptake in sigmoid colon with a SUVmax of 13.7 and TLG of 272 accompanied by wall thickening causing a mass lesion on CT component (arrows). Histopathology established the diagnosis as recurrence.
A female patient aged 51 years with rectum cancer was operated and treated by chemoradiotherapy. MRI findings revealed suspected metastasis with serum CEA and Ca 19-9 in normal range during the follow-up. Her axial PET (A), CT (B), fusion (C) and coronal PET (D), CT (E), fusion (F) images on 18F-FDG-PET/CT showed a focal uptake in sigmoid colon with a SUVmax of 13.7 and TLG of 272 accompanied by wall thickening causing a mass lesion on CT component (arrows). Histopathology established the diagnosis as recurrence.

Figure 4

A female patient aged 73 years with sigmoid colon cancer was operated and treated by chemoradiotherapy. Her serum CEA level was 3.2 ng/ml, and Ca 19-9 was 7.3 U/ml. In the evaluation of treatment response; axial PET (A), CT (B), fusion (C) and coronal PET (D), fusion (E) images on 18F-FDG-PET/CT exhibited a diffuse uptake in sigmoid colon with a SUVmax of 10.1 and TLG of 154 accompanied by wall thickening on CT component (arrows). This uptake raised the suspicion of a probable recurrence, but histopathology confirmed it as benign.
A female patient aged 73 years with sigmoid colon cancer was operated and treated by chemoradiotherapy. Her serum CEA level was 3.2 ng/ml, and Ca 19-9 was 7.3 U/ml. In the evaluation of treatment response; axial PET (A), CT (B), fusion (C) and coronal PET (D), fusion (E) images on 18F-FDG-PET/CT exhibited a diffuse uptake in sigmoid colon with a SUVmax of 10.1 and TLG of 154 accompanied by wall thickening on CT component (arrows). This uptake raised the suspicion of a probable recurrence, but histopathology confirmed it as benign.

18F-FDG-PET/CT results, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to final histopathologic diagnosis

Histopathologic diagnosis18F-FDG-PET/CT Results
PositiveNegativeSensitivitySpecificityPPVNPVTotal (n)
MalignantTP = 24FN = 024
BenignFP = 14TN = 1529
Total (n)3815100%51.7%63.1%100%53

Locations of pathologic FDG uptake

Sites of abnormal FDG uptaken
Anostomosis line (area)7
Rectum9
Rectosigmoid region11
Liver9
Caecum1
Kidney1
Abdominal mass4
Presacral mass5
Sigmoid region3
Descending colon2
Lung1

Overlap between 18F-FDG-PET/CT findings and conventional imaging modalities (CT or MRI) in histopathologically proven recurrence

18F-FDG-PET/CT results
CT/MRITrue positiveTrue negativeTotal (n)
Malignn617

FDG-PET/CT findings according to serum Ca 19-9 or CEA levels for histopathologically proven recurrence

18F-FDG-PET/CT results
Ca 19-9 or CEA levelsTrue positiveTrue negativeTotal (n)
Elevated9110
Normal131427
Total (n)221537
eISSN:
1581-3207
Language:
English
Publication timeframe:
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Journal Subjects:
Medicine, Clinical Medicine, Radiology, Internal Medicine, Haematology, Oncology
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