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Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging

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Abstract

Background

Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake.

Methods

Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions.

Results

Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions.

Conclusion

Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey

    Ahmet Cem Esmer, Hilmi Yazıcı & Şevket Cumhur Yeğen

  2. Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey

    Kevser Öksüzoğlu, Feyza Şen & Tunç Öneş

  3. Department of General Surgery, Osmaniye State Hospital, Osmaniye, Turkey

    Deniz Tazeoğlu

  4. Department of Radiology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey

    Rabia Ergelen

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  1. Ahmet Cem Esmer
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Contributions

ACE: Study conception and design, data acquisition, analysis of results, writing, visualization. KÖ: Study design, data acquisition, writing, visualization. FŞ: data processing, analysis of results, writing, editing. HYazıcı: study conception, data acquisition, data processing. DT: Data processing, analysis, and interpretation of results. RE: data acquisition, data processing. TÖ: Supervision, validation. SCY: supervision, validation. All authors critically revised the manuscript, approved the final version to be published, and agreed to be accountable for all aspects of the work.

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Correspondence to Ahmet Cem Esmer.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The Marmara University Scientific Research Ethics Committee approved the study by date 08.02.2022 with decision number 2022/106. During the study, all procedures were carried out in accordance with the ethical rules and the principles of the Declaration of Helsinki.

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Esmer, A.C., Öksüzoğlu, K., Şen, F. et al. Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging. World J Surg 47, 2532–2541 (2023). https://doi.org/10.1007/s00268-023-07135-w

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