Prospective evaluation of ^(18)F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases  

作　　者：Tim Akhurst Mithat Gönen Raymond E.Baser Lawrence H.Schwartz Scott Tuorto Lynn A.Brody Anne Covey Karen T.Brown Steven M.Larson Yuman Fong 

机构地区：[1]Department of Radiology,Memorial Sloan-Kettering Cancer Center,New York,NY,USA [2]Peter MacCallum Cancer Centre,Victoria,Australia [3]Department of Epidemiology and Biostatistics,Memorial Sloan-Kettering Cancer Center,New York,NY,USA [4]Department of Surgery,Memorial Sloan-Kettering Cancer Center,New York,NY,USA

出　　处：《Hepatobiliary Surgery and Nutrition》2022年第4期539-554,共16页肝胆外科与营养（英文）

基　　金：This work was supported in part by grant NIH-R01CA/DK80982-01 from the National Institutes of Health and a grant the FAMRI.

摘　　要：Background:Despite considerable advances in preoperative imaging,up to one-third of patients operatively explored for hepatic colorectal metastases are unexpectedly found to harbor unresectable intrahepatic or extrahepatic disease.Methods:The current study is a prospective,blinded study comparing utility of[18F]2-fluoro-2-deoxyglucose positron emission tomography(18F-FDG-PET)to computed tomography(CT)and CT arterial portography(CTAP)as preoperative staging.Results:The 125 planned subjects were enrolled.Findings seen on FDG-PET alone changed therapy for 23 of 125 patients(18%).FDG-PET confirmed other radiologic findings in 16 cases(13%),for an overall influence on therapy in 39 cases(31%).FDG-PET was the most sensitive diagnostic imaging test for extrahepatic cancer;it was 80-90%sensitive for extrahepatic cancer and 70-90%specific.For the 28 cases of unresectable disease due to extrahepatic disease,FDG-PET findings solely changed therapies in 16 cases(57%)and influenced therapy in seven other cases(25%).Of the 21 unresectable cases due to extent of intrahepatic disease,FDG-PET did not solely change therapy in any.Overall,FDG-PET had the lowest sensitivity for hepatic sites compared with CT or CTAP.In particular,small(<1 cm)liver tumors were particularly poorly detected by FDG-PET.The area under the receiver operating characteristic(ROC)curve for small tumors was 0.58 and for patients on chemotherapy it was 0.66,a modest improvement over no imaging.Conclusions:FDG-PET is an important test for preoperative staging of patients with hepatic colorectal metastases,affecting treatment decisions in nearly one-third of patients.The high yield is due mainly to detection of extrahepatic disease.It is therefore recommended in patients with extrahepatic lesions suspected to be disseminated cancer or those with high risk for extrahepatic disease.It is not a good test for identification of small tumors in the liver.

关 键 词：Positron emission tomography(PET) computed tomography(CT) COLORECTAL HEPATIC METASTASES SURGERY 

分 类 号：R735.35[医药卫生—肿瘤]