Diagnostic accuracy of (18)F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins
Journal Title: Journal of Cancer Research & Therapy - Year 2013, Vol 1, Issue 1
Abstract
Purpose: to evaluate the diagnostic accuracy of (18) F-FDG positron emission tomography/ computerized tomography (PET/CT) for the detection of peritoneal carcinomatosis (PC) of colorectal cancer (CRC). Methods: one hundred and forty six eligible patients referred for a PET/CT to evaluate CRC at a single institution were included consecutively and retrospectively. After joint training on 20 similar patient files, two nuclear physicians reviewed the PET/CT scans blindly and independently using a method specifically designed for PC detection. The gold standard was either histological results from surgical exploration for resected patients (n=65) or clinical follow up defined as the 3-month CT follow up supplemented by one year of clinical information and CT monitoring for non-resected patients (n=81). As secondary objectives we evaluated the interobserver reliability between the two PET/CT readings and the diagnostic accuracy of a contemporary ceCT (n=69) or CT component of the PET/CT (n=77) reviewed by an independent radiologist . The extent of PC according to a simplified Sugarbaker index (PCI) was examined for the operated subgroup, when PCI was available from the surgeon and PET/CT (n=12). Results: according to the gold standard, 35/146 patients had PC (including 19 of 65 patients with histological gold standard and 16 of 81 patients with clinical follow up gold standard). Sensitivity and specificity of PET/CT were 88% and 96% respectively and positive and negative predictive values and accuracy, 88%, 96% and 94% respectively. For CT alone, the corresponding values were: 68%, 92%, 72%, 90% and 86%. The interobserver agreement for the detection of peritoneal carcinomatosis in PET/CT showed high agreement at 0.91 (Kappa). Median PCI was 3 [range: 1–13] when assessed by surgeons and 4 [range: 1–10] on PET/CT. Focal uptake was the most frequently observed sign on PET. Conclusions: PET/CT appears to be an accurate and reproducible test for PC diagnosis in colorectal cancer using an interpretation method specifically designed for PC detection. To confirm these results and to evaluate peritoneal carcinomatosis extension accurately, a prospective observational study using iodine contrast-enhanced PET/CT as a first imaging technique for pre-operative staging and potentially involving further independent reviewers remains to be undertaken.
Authors and Affiliations
Bullier E, Descat E, Bonichon F, Picat MQ, Bellera C, Evrard S, Cazeau AL
Keywords
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