Diagnostic value of FDG-PET/CT for lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy
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The aim of this study was to elucidate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography (PET)–computed tomography (CT) for lateral pelvic lymph node (LPN) metastasis in rectal cancer treated with preoperative chemoradiotherapy (CRT).
Eighteen rectal cancer patients with enlarged (≥ 8 mm) LPNs were treated with CRT followed by total mesorectal excision with LPN dissection during 2012–2015. After CRT, LPN maximum standard uptake values (SUVmax) were measured using PET/CT and long diameters of LPNs were measured using CT or magnetic resonance imaging (MRI). LPN size and SUVmax were compared with pathological status in the resected specimen. Radiologically identified nodes were matched with surgically resected nodes by separate examination of 4 lymph nodal regions: internal iliac, obturator, external iliac and common iliac lymph nodes.
In total, 34 LPNs were located by CT or MRI. Metastatic LPNs were significantly larger than non-metastatic LPNs (size, mean ± standard deviation: 13.0 ± 8.3 vs. 4.9 ± 3.5 mm, p < 0.01). SUVmax was determinable for 28 of the LPNs, among which metastatic LPNs were found to have significantly higher SUVmax than non-metastatic LPNs (mean ± standard deviation: 2.2 ± 1.3 vs. 1.2 ± 0.3, p < 0.01). Receiver operating characteristic analysis suggested optimal cutoff values of size = 12 mm which had an accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 82.1, 70.6, 100, 100, and 68.8%, respectively. An SUVmax = 1.6 had an accuracy, sensitivity, specificity, PPV, and NPV of 85.7, 76.5, 100, 100, and 73.3%, respectively. When LPNs that were ≥ 12 mm in size and/or had an SUV ≥ 1.6, the accuracy, sensitivity, specificity, PPV, and NPV were 92.9, 88.2, 100, 100, and 84.6%, respectively.
After CRT, PET/CT alone or in combination with CT and MRI can predict the presence of metastatic LPN with a high degree of accuracy. PET/CT may be useful in selecting patients with rectal cancer who would benefit from LPN dissection in addition to TME. These results need to be confirmed by larger studies.
KeywordsRectal cancer Chemoradiotherapy Lateral pelvic lymph node Positron emission tomography
This research is supported by Grants-in-Aid for Scientific Research (A: Grant Number; 16H02672, C: Grant Number; 16K07143, and C: Grant Number; 16K07161) from Japan Society for the Promotion of Science. This research is supported by the Project for Cancer Research and Therapeutic Evolution (P-CREATE, Grant Number: 16cm0106502h0001) from the Japan Agency for Medical Research and Development (AMED).
Compliance with ethical standards
Conflict of interest
Toshiaki Watanabe serves as an adviser to Taiho and received a research grant and lecture fees from Taiho. The remaining authors declare that they have no conflict of interest.
The research was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments.
Informed consent was given by all patients.