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The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Recent data confirmed the importance of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the selection of patients with colorectal hepatic metastases for surgery. Neoadjuvant chemotherapy before hepatic resection in selected cases may improve outcome. The influence of chemotherapy on the sensitivity of FDG-PET and CT in detecting liver metastases is not known.

Methods

Patients were assigned to either neoadjuvant treatment or immediate hepatic resection according to resectability, risk of recurrence, extrahepatic disease, and patient preference. Two-thirds of them underwent FDG-PET/CT before chemotherapy; all underwent preoperative contrast-enhanced CT and FDG-PET/CT. Those without extensive extrahepatic disease underwent open exploration and resection of all the metastases according to original imaging findings. Operative and pathological findings were compared to imaging results.

Results

Twenty-seven patients (33 lesions) underwent immediate hepatic resection (group 1), and 48 patients (122 lesions) received preoperative neoadjuvant chemotherapy (group 2). Sensitivity of FDG-PET and CT in detecting colorectal (CR) metastases was significantly higher in group 1 than in group 2 (FDG-PET: 93.3 vs 49%, P < 0.0001; CT: 87.5 vs 65.3, P = 0.038). CT had a higher sensitivity than FDG-PET in detecting CR metastases following neoadjuvant therapy (65.3 vs 49%, P < 0.0001). Sensitivity of FDG-PET, but not of CT, was lower in group 2 patients whose chemotherapy included bevacizumab compared to patients who did not receive bevacizumab (39 vs 59%, P = 0.068).

Conclusions

FDG-PET/CT sensitivity is lowered by neoadjuvant chemotherapy. CT is more sensitive than FDG-PET in detecting CR metastases following neoadjuvant therapy. Surgical decision-making requires information from multiple imaging modalities and pretreatment findings. Baseline FDG-PET and CT before neoadjuvant therapy are mandatory.

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Acknowledgment

Esther Eshkol is thanked for editorial assistance.

Conflict of interest statement

None declared

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Authors and Affiliations

  1. Liver Surgery Unit of The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Nir Lubezky, Richard Nakache & Menahem Ben-Haim

  2. Department of Surgery B, The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv, 64239, Israel

    Nir Lubezky, Joseph M. Klausner & Menahem Ben-Haim

  3. Department of Oncology of The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Ravit Geva, Einat Shmueli & Arie Figer

  4. Institute of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Ur Metser & Einat Even-Sapir

Authors
  1. Nir Lubezky
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  2. Ur Metser
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  3. Ravit Geva
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  4. Richard Nakache
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  5. Einat Shmueli
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  6. Joseph M. Klausner
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  7. Einat Even-Sapir
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  8. Arie Figer
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  9. Menahem Ben-Haim
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Corresponding author

Correspondence to Nir Lubezky.

Additional information

The abstract was presented before the 58th Cancer Symposium of the Society of Surgical Oncology, Atlanta, GA, USA, 2005, and before the 2005 Congress of the American Hepato-Pancreato-Biliary Association, Fort-Lauderdale, FL, USA.

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Lubezky, N., Metser, U., Geva, R. et al. The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings. J Gastrointest Surg 11, 472–478 (2007). https://doi.org/10.1007/s11605-006-0032-8

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  • DOI: https://doi.org/10.1007/s11605-006-0032-8

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