FDGPET in the Diagnosis and Initial Staging of Colorectal Carcinoma

FDG-PET can usually differentiate benign from malignant lesions (hepatic and pulmonary lesions, indeterminate lymph nodes) and can play an important role in the evaluation of patients with rising tumor markers in the absence of a known source of disease. When these lesions (or metastases) are found with FDG-PET, they may lead to a cancellation of surgery in these patients.

Abdel-Nabi et al.251 and Kantorova et al.252 demonstrated that FDG-PET had a high sensitivity for detection of distant metastases, particularly in the liver, but neither FDG-PET nor

CT was sensitive enough to reliably detect local lymph node involvement. FDG-PET was, however, superior to CT for detecting hepatic metastases, with a sensitivity and specificity of 88% and 100%, respectively, compared with 38% and 97% for CT.251

Mukai et al.253 reported that FDG-PET changed the treatment modality in 8% of patients and the extent of surgery in 13%. In a study of 110 patients, Yasuda et al.254 showed that precancerous adenomatous polyps could be detected with a sensitivity of 24% for lesions from 5 to 30 mm in size and of 90% for lesions greater than 13mm.

Although there are false-positive findings such as abscesses, fistulas, diverticulitis, and adenomas, the identification of focal uptake should not be ignored. However, the impact on patient management is not high because most patients will undergo surgery anyway, and staging is usually performed with preoperative liver ultrasound and during surgery. PET results may have a role in changing the type of surgery (curative versus palliative or concomitant liver metastases resection).

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