J Clin Oncol 2002 Jan 15;20(2):388-95
Value of positron emission tomography with [F-18]fluorodeoxyglucose in
patients with colorectal liver metastases: a prospective study.
Ruers TJ, Langenhoff BS, Neeleman N, Jager GJ, Strijk S, Wobbes T, Corstens FH,
Oyen WJ.
PURPOSE: To assess prospectively the value of fluor-18-deoxyglucose (FDG)
positron emission tomography (PET), in addition to conventional diagnostic
methods (CDM), as a staging modality in candidates for resection of colorectal
liver metastases. PATIENTS AND METHODS: In 51 patients analyzed for resection of
colorectal liver metastases, clinical management decisions were recorded after a
complete work-up with CDM. Afterward, FDG-PET scans were performed and any
change of clinical management according to FDG-PET results was carefully
documented. Discordances between FDG-PET and CDM results were identified and
related to the final diagnosis by histopathology, intraoperative findings, and
follow-up. RESULTS: In 10 (20%) out of 51 patients, clinical management
decisions based on CDM were changed after FDG-PET findings were known. FDG-PET
detected unresectable pulmonary (n = 5) and hepatic metastases (n = 1) and ruled
out extrahepatic (n = 2) and hepatic disease (n = 2). Due to FDG-PET, eight
patients were spared unwarranted liver resection or laparotomy and two other
patients were identified as candidates for liver resection. When the results of
FDG-PET were regarded as decisive in a retrospective analysis, potential change
of management was 29% (15 patients). FDG-PET and CDM showed discordant
extrahepatic results in 11 patients (22%) and discordant hepatic results in
eight patients (16%). Compared with CDM, FDG-PET resulted in true upstaging (n =
11), true downstaging (n = 5), false upstaging (n = 1), and false downstaging (n
= 2). The detection rate of liver metastases on a lesion basis was generally
better for computed tomography than for FDG-PET (80% v 65%); this was related to
tumor size. CONCLUSION: FDG-PET as a complementary staging method improves the
therapeutic management of patients with colorectal liver metastases, especially
by detecting unsuspected extrahepatic disease.
