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Clinical Effectiveness of Preoperative 18F-FDG PET/CT in Predicting Pathological Tumor Grade in Patients with Pseudomyxoma Peritonei Originating from Appendix: A Retrospective Cohort Study

  • Peritoneal Surface Malignancy
  • Published:
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Abstract

Background

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the standard treatment for patients with pseudomyxoma peritonei (PMP). In some malignancies, the standard uptake value of positron emission tomography with 2-deoxy-2-18F-fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) is now accepted as a reliable indicator of neoplastic behavior. This study aimed to evaluate the association between the maximum standardized uptake value (SUVmax) and pathological grade in patients with PMP and to investigate the significance of SUVmax in the preoperative assessment of these patients.

Patients and Methods

In this retrospective single-center study, consecutively enrolled patients diagnosed with PMP of appendiceal origin underwent preoperative 18F-FDG PET/CT. SUVmax was calculated as the highest SUVmax value in the abdomen excluding the primary site. SUVmax was compared with the pathological grade (low or high grade) of PMP tumors according to the World Health Organization classification and further analyzed with respect to the estimated cutoff point, sensitivity, specificity, and receiver operating characteristic.

Results

In total, 160 patients were included. CRS was successfully performed in 93 patients and palliative debulking surgery in 67 patients. The pathological grade was high in 45 patients and low in 115. High-grade patients had a higher median SUVmax on 18F-FDG PET/CT than did low-grade patients (3.83 versus 2.34, p < 0.001). The highest area under the curve was 0.81, with a sensitivity of 77.8%, specificity of 72.3%, and cutoff point of 2.63.

Conclusion

This study suggests that the SUVmax of preoperative 18F-FDG PET/CT is associated with the pathological grade in patients with PMP.

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References

  1. Moran BJ, Cecil TD. The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin. 2003;12(3):585–603. https://doi.org/10.1016/S1055-3207(03)00026-7.

    Article  Google Scholar 

  2. Panarelli NC, Yantiss RK. Mucinous neoplasms of the appendix and peritoneum. Arch Pathol Lab Med. 2011;135(10):1261–8. https://doi.org/10.5858/arpa.2011-0034-RA.

    Article  PubMed  Google Scholar 

  3. Smeenk RM, van Velthuysen MLF, Verwaal VJ, Zoetmulder FAN. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol EJSO. 2008;34(2):196–201. https://doi.org/10.1016/j.ejso.2007.04.002.

    Article  CAS  PubMed  Google Scholar 

  4. Sugarbaker PH, Schellinx MET, Chang D, Koslowe P, von Meyerfeldt M. Peritoneal carcinomatosis from adenocarcinoma of the colon. World J Surg. 1996;20(5):585–92. https://doi.org/10.1007/s002689900091.

    Article  CAS  PubMed  Google Scholar 

  5. Lin YL, Xu DZ, Li XB, et al. Consensuses and controversies on pseudomyxoma peritonei: a review of the published consensus statements and guidelines. Orphanet J Rare Dis. 2021;16(1):85. https://doi.org/10.1186/s13023-021-01723-6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Govaerts K, Lurvink RJ, De Hingh IHJT, et al. Appendiceal tumours and pseudomyxoma peritonei: literature review with PSOGI/EURACAN clinical practice guidelines for diagnosis and treatment. Eur J Surg Oncol. 2021;47(1):11–35. https://doi.org/10.1016/j.ejso.2020.02.012.

    Article  CAS  PubMed  Google Scholar 

  7. Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol. 1995;19(12):1390–408. https://doi.org/10.1097/00000478-199512000-00006.

    Article  CAS  PubMed  Google Scholar 

  8. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. WHO Classif Tumours Dig Syst. 2010;(Ed. 4). Accessed June 13, 2023. https://www.cabdirect.org/cabdirect/abstract/20113051318

  9. Carr NJ, Cecil TD, Mohamed F, et al. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia. Am J Surg Pathol. 2016;40(1):14–26. https://doi.org/10.1097/PAS.0000000000000535.

    Article  PubMed  Google Scholar 

  10. González-Moreno S, Sugarbaker PH. Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding. Br J Surg. 2004;91(3):304–11. https://doi.org/10.1002/bjs.4393.

    Article  PubMed  Google Scholar 

  11. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: PH Sugarbaker, editor. Peritoneal Carcinomatosis: Principles of Management. US: Cancer Treat Res Springer; 1996. p. 359–74. https://doi.org/10.1007/978-1-4613-1247-5_23.

    Chapter  Google Scholar 

  13. Passot G, Glehen O, Pellet O, et al. Pseudomyxoma peritonei: role of 18F-FDG PET in preoperative evaluation of pathological grade and potential for complete cytoreduction. Eur J Surg Oncol EJSO. 2010;36(3):315–23. https://doi.org/10.1016/j.ejso.2009.09.001.

    Article  CAS  PubMed  Google Scholar 

  14. Hotta M, Minamimoto R, Gohda Y, Igari T, Yano H. Impact of a modified peritoneal cancer index using FDG-PET/CT (PET-PCI) in predicting tumor grade and progression-free survival in patients with pseudomyxoma peritonei. Eur Radiol. 2019;29(10):5709–16. https://doi.org/10.1007/s00330-019-06102-1.

    Article  PubMed  Google Scholar 

  15. Dubreuil J, Giammarile F, Rousset P, et al. FDG-PET/ceCT is useful to predict recurrence of Pseudomyxoma peritonei. Eur J Nucl Med Mol Imaging. 2016;43(9):1630–7. https://doi.org/10.1007/s00259-016-3347-z.

    Article  CAS  PubMed  Google Scholar 

  16. Kitajima K, Nakajo M, Kaida H, et al. Present and future roles of FDG-PET/CT imaging in the management of gastrointestinal cancer: an update. Nagoya J Med Sci. 2017;79(4):527–43. https://doi.org/10.18999/nagjms.79.4.527.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms. Am J Roentgenol. 2000;174(4):1005–8. https://doi.org/10.2214/ajr.174.4.1741005.

    Article  CAS  Google Scholar 

  18. Bakheet SMB, Powe J, Kandil A, Ezzat A, Rostom A, Amartey J. F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med. 2000;25(2):100.

    Article  CAS  PubMed  Google Scholar 

  19. Hustinx R, Smith RJ, Benard F, et al. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med. 1999;26(10):1345–8. https://doi.org/10.1007/s002590050593.

    Article  CAS  PubMed  Google Scholar 

  20. Shreve PD. Focal fluorine-18 fluorodeoxyglucose accumulation in inflammatory pancreatic disease. Eur J Nucl Med. 1998;25(3):259–64. https://doi.org/10.1007/s002590050226.

    Article  CAS  PubMed  Google Scholar 

  21. Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. RadioGraphics. 1999;19(1):61–77. https://doi.org/10.1148/radiographics.19.1.g99ja0761.

    Article  CAS  PubMed  Google Scholar 

  22. Ichiya Y, Kuwabara Y, Sasaki M, et al. FDG-PET in infectious lesions: the detection and assessment of lesion activity. Ann Nucl Med. 1996;10(2):185–91. https://doi.org/10.1007/BF03165391.

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported in part by a grant from the National Center for Global Health and Medicine (Grant No. 21A1003).

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Authors and Affiliations

  1. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan

    Kenta Aso MD & Yoshimasa Gohda MD

  2. Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan

    Masatoshi Hotta MD, PhD & Ryogo Minamimoto MD, PhD

  3. Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan

    Yosuke Shimizu PhD & Yukari Uemura PhD

  4. Consultant Colorectal Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Hideaki Yano MD, PhD

Authors
  1. Kenta Aso MD
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  2. Yoshimasa Gohda MD
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  3. Masatoshi Hotta MD, PhD
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  4. Ryogo Minamimoto MD, PhD
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  5. Yosuke Shimizu PhD
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  7. Hideaki Yano MD, PhD
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Corresponding author

Correspondence to Yoshimasa Gohda MD.

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Ethical Approval

The study protocol was reviewed and approved by the National Center for Global Health and Medicine Research Ethics Committee and its institutional review board (approval no. NCGM-G-003221-00). All surgeries were performed after obtaining informed consent from each patient.

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Aso, K., Gohda, Y., Hotta, M. et al. Clinical Effectiveness of Preoperative 18F-FDG PET/CT in Predicting Pathological Tumor Grade in Patients with Pseudomyxoma Peritonei Originating from Appendix: A Retrospective Cohort Study. Ann Surg Oncol 31, 1990–1995 (2024). https://doi.org/10.1245/s10434-023-14755-y

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