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Endoscopic Evaluation of PET/CT Abnormalities in the Gastrointestinal Tract: Yield and Approach

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Abstract

Background

Unexpected hypermetabolic activity is often encountered in the gastrointestinal tract when PET/CT is performed for various indications, prompting endoscopic evaluation. Our aim was to characterize the types of lesions seen in segments of the gastrointestinal tract with unexpected PET/CT abnormalities as well as clinically significant lesions seen on endoscopy which did not produce a PET/CT abnormality to guide the endoscopist tasked with evaluating these imaging findings.

Methods

We retrospectively reviewed a database of endoscopies performed at City of Hope Comprehensive Cancer Center between January 1, 2016 and September 30, 2021 for an indication of “abnormal PET.” We divided the gastrointestinal tract into segments and defined categories of endoscopic/histologic findings for each segment. We counted the number of segments with an abnormal PET/CT finding and corresponding endoscopic/histologic abnormality as well as the number of segments with an endoscopic/histologic abnormality but normal PET/CT.

Results

PET/CT identified 209 segments with hypermetabolic activity, 109 of which had corresponding endoscopic/histologic abnormalities. In the jejunum and ileum, all corresponding lesions were malignant. Seventy-three percent of corresponding lesions in the stomach were H. pylori positive. PET/CT failed to detect 34.7% of clinically significant lesions diagnosed endoscopically, including 1 malignancy in the transverse colon and many inflammatory or low-risk premalignant lesions.

Conclusion

PET/CT abnormalities seen in the small bowel should be evaluated urgently as nearly all correlates were malignant, while abnormalities in the stomach should prompt workup for H. pylori. Most lesions missed by PET/CT were inflammatory or low-risk premalignant yet clinically significant, confirming the need to inspect the entirety of the upper or lower gastrointestinal tract during endoscopy.

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Authors and Affiliations

  1. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Harry Trieu

  2. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Sadie De Silva

  3. Department of Radiology, City of Hope National Medical Center, Duarte, CA, USA

    Saro Manoukian

  4. Department of Gastroenterology, University of California San Francisco at Fresno, Fresno, CA, USA

    Anand Rajan

  5. Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA

    Rifat Mannan & Yu Liang

  6. Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA

    Jeffrey K. Lee

  7. Department of Gastroenterology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA

    James Lin & Trilokesh D. Kidambi

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  1. Harry Trieu
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  2. Sadie De Silva
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  3. Saro Manoukian
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  6. Yu Liang
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  7. Jeffrey K. Lee
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  9. Trilokesh D. Kidambi
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Contributions

HT, TK, SD: Study design, data collection, data analysis, manuscript drafting. AR, JKL, JL: Study design, manuscript review. SM, RM: Review and interpretation of radiographic studies, manuscript review. YL: Review of histology, manuscript review.

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Correspondence to Trilokesh D. Kidambi.

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Trieu, H., De Silva, S., Manoukian, S. et al. Endoscopic Evaluation of PET/CT Abnormalities in the Gastrointestinal Tract: Yield and Approach. Dig Dis Sci 69, 552–561 (2024). https://doi.org/10.1007/s10620-023-08231-6

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  • DOI: https://doi.org/10.1007/s10620-023-08231-6

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