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Lau JHYH, Ng KK, Wong WC, Ng KS, Chu KS, Au-Yong TK, Kung BT. Retrospective study of qualitative assessment in detecting synchronous and metachronous malignancies in adult cancer patients by 18 F-FDG PET/CT. Nucl Med Commun 2024; 45:710-717. [PMID: 38726624 DOI: 10.1097/mnm.0000000000001857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The study aimed to evaluate the frequency of incidental suspicious lesions detected by flourine-18 fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) scans done for staging or restaging in adult cancer patients. We further determined the detection rate of synchronous and metachronous malignancies in these suspicious lesions after further investigations. MATERIALS AND METHODS This retrospective analysis evaluated the consecutive patients with 18 F-FDG PET/CT scans done in Queen Elizabeth Hospital (QEH), Hong Kong between July 2021 and June 2022. The adult cancer patients who underwent staging or restaging 8 F-FDG PET/CT were included while the remaining were excluded. Patients' demographics, primary cancer type, tumor markers, and pathological analyses for the incidental suspicious lesions were reviewed to establish the detection rate of synchronous and metachronous malignancies. RESULTS A total of 2054 patients fulfilled inclusion criteria with age ranging from 18 to 93 years old. Out of the 2054 patients, 304 (14.8%) were found to have incidental suspicious lesions. Of these, 206 patients (67.8%) underwent further investigations including pathological analyses. Subsequently, 84 of these 206 patients (40.8%) had pathologically proven synchronous or metachronous malignancies. CONCLUSION The detection rate of incidental suspicious lesions in adult cancer patients who underwent 18 F-FDG PET/CT scans for staging or restaging was 14.8% and the rate of synchronous and metachronous malignancies in these suspicious lesions was 40.8%. The treatment plan of these patients may potentially be altered, which should be included in the cost-benefit analysis of using this imaging modality.
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Affiliation(s)
- Jeremy Hugh Yen-Hey Lau
- Nulcear Medicine Unit, Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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Lee H, Hwang KH. Focal incidental colorectal fluorodeoxyglucose uptake: Should it be spotlighted? World J Clin Cases 2024; 12:2466-2474. [PMID: 38817235 PMCID: PMC11135452 DOI: 10.12998/wjcc.v12.i15.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a cornerstone in cancer evaluation imaging, with a well-established history spanning several years. This imaging modality, encompassing the examination of the body from the base of the skull to the upper thighs, comprehensively covers the chest and abdominopelvic regions in a singular scan, allowing for a holistic assessment of nearly the entire body, including areas of marginal interest. The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas. The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence, albeit fraught with challenges associated with non-specific FDG uptake. The presence of benign colorectal lesions or physiological uptake poses a particular obstacle, as these may manifest with FDG uptake levels that mimic malignancy. Consequently, physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas. Existing studies have presented divergent results concerning these uptakes. Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images. In this article, we aim to succinctly explore the distinctive characteristics of FDG, delve into imaging findings, and elucidate the clinical significance of incidental focal colorectal uptake. This discussion aims to contribute valuable insights into the nuanced interpretation of such findings, fostering a comprehensive understanding.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Zhang R, Abudurexiti M, Qiu W, Huang P, Hu P, Fan W, Zhang Z. Assessment of water enema PET/CT: an effective imaging technique for the diagnosis of incidental colorectal 18F-FDG uptake. BMC Med Imaging 2024; 24:11. [PMID: 38172764 PMCID: PMC10765618 DOI: 10.1186/s12880-023-01186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To validate the feasibility of water enema PET/CT (WE-PET/CT) in incidental colorectal 18F-FDG uptake and improve the accuracy of diagnosing colorectal neoplastic lesions. METHODS We retrospectively analysed the electronic records of 338 patients undergoing common PET/CT and WE-PET/CT at our hospital. PET/CT results were correlated with colonoscopy pathology and follow-up results. The ROC contrast curve was plotted to evaluate the accuracy of SUVmax on common PET/CT and WE-PET/CT for detecting neoplastic lesions. SUVmax and the median retention indexes (RIs) of cancerous, precancerous, and benign lesions and physiologic uptake were compared. RESULTS The sensitivity, specificity and accuracy of diagnosing neoplastic lesions with common PET/CT were 84.0%, 78.3% and 80.2%, respectively. The corresponding results with WE-PET/CT were 95.8%, 96.5% and 96.2%. The AUC of SUVmax on WE-PET/CT was significantly higher than that on common PET/CT (0.935 vs. 0.524, p < 0.001). The median SUVmax on WE-PET/CT was significantly higher than that on common PET/CT in cancerous and precancerous lesions, and significantly decreased in benign lesions and physiologic uptake (p < 0.001). The RI was significantly different between cancerous lesions and physiologic uptake, between precancerous lesions and physiologic uptake, between benign lesions and physiologic uptake, and between cancerous and benign lesions (p < 0.05). CONCLUSIONS WE-PET/CT is a noninvasive, well-tolerated and effective technique for diagnosing incidental colorectal 18F-FDG uptake. It is helpful for a timely colonoscopy and can effectively avoid an unnecessary colonoscopy for incidental colorectal 18F-FDG uptake.
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Affiliation(s)
- Rongqin Zhang
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- Department of Nuclear Medicine and Molecular Imaging, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Meilinuer Abudurexiti
- Department of Nuclear Medicine, The First People's Hospital of Xinjiang Kashgar Area, Kashgar, Xinjiang, 844000, China
| | - Wanglin Qiu
- Department of Nuclear Medicine and Molecular Imaging, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Pinbo Huang
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ping Hu
- Department of Nuclear Medicine and Molecular Imaging, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wei Fan
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Zhanwen Zhang
- Department of Nuclear Medicine and Molecular Imaging, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
- Department of Nuclear Medicine, The First People's Hospital of Xinjiang Kashgar Area, Kashgar, Xinjiang, 844000, China.
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Ekmen MÖ, Aksoy EK. Evaluation of patients via colonoscopy who underwent positron emission tomography/computerized tomography due to colon involvement. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230409. [PMID: 37792869 PMCID: PMC10547485 DOI: 10.1590/1806-9282.20230409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Fluorodeoxyglucose is not a tumor-specific agent and it can also be involved in benign conditions, which may cause diagnostic confusion. This research aims to elucidate the colonoscopic findings of patients who underwent colonoscopy due to colon involvement in positron emission tomography/computerized tomography. METHODS A total of 71 patients who underwent colonoscopy due to colonic involvement in positron emission tomography/computerized tomography at SBU Keçiören Training and Research Hospital Gastroenterology Clinic Endoscopy Unit have been analyzed retrospectively. Demographic characteristics of the patients, areas of involvement in positron emission tomography/computerized tomography, and severity have been obtained from the hospital database. RESULTS The gastrointestinal involvement area of 22.5% (n=16) of the patients was ascending colon, 15.5% (n=11) was sigmoid, 15.5% (n=11) was rectum, 12.7% (n=9) was stomach, 11.3% (n=8) was transverse colon, 8.5% (n=6) was anal canal, 5.6% (n=4) was esophagus, and 5.6% (n=4) was descending colon. The endoscopic findings of 19.7% (n=14) patients were normal, whereas 29.6% (n=21) had polyps, 9.9% (n=7) had cancer, 2.8% (n=2) had an ulcer, 15.5% (n=11) had gastritis, 14.1% (n=10) had hemorrhoids, and 7% (n=5) had colitis. CONCLUSION Fluorodeoxyglucose-positron emission tomography can detect unexpected distant metastases with high sensitivity because it allows whole-body imaging. Curative resection significantly contributes to the choice of treatment modality in the pre-operative period of colorectal cancer patients with planned surgery.
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Affiliation(s)
- Mehmet Önder Ekmen
- Ankara SBU Keçiören Training and Research Hospital Gastroenterology Clinic – Ankara, Turkey
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Godefroy J, Ben Haim S, Rosenbach E, Meital AN, Levy A, Chicheportiche A, Bar-Shalom R. Perceptual omission errors in positron emission tomography and computed tomography reporting. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:75-82. [PMID: 33686849 DOI: 10.23736/s1824-4785.21.03339-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Omission errors in medical imaging can lead to missed diagnosis and harm to patients. The subject has been studied in conventional imaging, but no data is available for functional imaging in general and for PET/CT in particular. In this work, we evaluated the frequency and characteristics of perceptual omission errors in the PET component of oncologic PET/CT imaging, and we analyzed the hazardous scenarios prone to such modality-specific errors. METHODS Perceptual omission errors were collected in one tertiary center PET/CT clinic during routine PET/CT reporting over a 26-month period. The omissions were detected either in reporting follow-up PET/CT studies of the same patient or during multidisciplinary meetings. RESULTS Significant omission errors were found in 1.2% of the 2100 reports included in the study. The most common omissions were bone metastases and focal colon uptake. We identified six PET-specific causative factors contributing to the occurrence of omissions, and we propose solutions to minimize their influence. CONCLUSIONS The data presented here can help to promote the awareness of interpreting physicians to body areas that require higher attention and to implement reading strategies for improving the accuracy of PET/CT interpretation.
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Affiliation(s)
- Jeremy Godefroy
- Department of Nuclear Medicine and Biophysics, Hadassah Hebrew University Medical Center, Jerusalem, Israel -
| | - Simona Ben Haim
- Department of Nuclear Medicine and Biophysics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK
| | - Eyal Rosenbach
- Department of Nuclear Medicine and Biophysics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aaron N Meital
- Department of Nuclear Medicine and Biophysics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Adi Levy
- Department of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alexandre Chicheportiche
- Department of Nuclear Medicine and Biophysics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rachel Bar-Shalom
- Department of Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Gökden Y, Özülker F, Özülker T. Prevalence and Clinical Significance of Incidental Focal 18F-FDG Uptake in Colon on PET/CT Imaging. Mol Imaging Radionucl Ther 2022; 31:96-103. [PMID: 35770960 PMCID: PMC9246315 DOI: 10.4274/mirt.galenos.2022.38247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The present study aimed to identify the prevalence of focal uptake in the colon on 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies performed for the evaluation of malignancies other than colon, to detect the rate of malignancy in incidental focal 18F-FDG avid colonic lesions and to investigate if any possible role of maximum standardized uptake value (SUVmax) values in the discrimination of malignant lesions from premalignant and benign ones exist. Methods: We retrospectively reviewed the files of 8,017 patients with known or suspected malignancy, who underwent whole-body 18F-FDG PET/CT at our institution during the period November 2017 to November 2019. Patients showing a single site of focally increased colonic 18F-FDG uptake that was more intense compared to liver uptake on 18F-FDG PET studies and referred to colonoscopy were enrolled in the study. Results: Fifty two patients (83.8%) had at least 1 corresponding lesion on colonoscopy, whereas in 10 patients no lesion was detected. Subsequent histopathological examinations revealed no corresponding lesion in 13 (13.7%), a benign lesion in 18 (18.9%), hyperplastic polyp in 10 (10.5%), low-grade polyp in 16 (16.8%), high-grade polyp in 29 (30.5%) and malignant lesion in 9 (9.5%) of the focal 18F-FDG uptake sites. According to histopathology results, statistically no significant difference was found between the SUVmax measurements of malignant and benign cases (p>0.05) but the average SUVmax measurements of malignant cases were found to be significantly higher than lower + high-grade cases (p<0.05) and hyperplastic polyp cases (p<0.01). Conclusion: In conclusion, any unexpected focal 18F-FDG uptake in 18F-FDG PET/CT studies is suspicious for malignancy and should be clarified by colonoscopy. The intensity of 18F-FDG uptake does not preclude the application of colonoscopy and histopathological verification of the lesion if there is any.
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Affiliation(s)
- Yasemin Gökden
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Internal Medicine, İstanbul, Turkey
| | - Filiz Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tamer Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Albertsen LN, Jaensch C, Tornbjerg SM, Teil J, Madsen AH. Correlation between incidental focal colorectal FDG uptake on PET/CT and colonoscopic and histopathological results. Scand J Gastroenterol 2022; 57:246-252. [PMID: 34735311 DOI: 10.1080/00365521.2021.1998602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE AND AIMS The primary aim of this study was to evaluate the correlation between incidental focal colorectal foci on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) with colonoscopic and histopathological results. The secondary aim was to determine to what extent these findings led to a change in patient management. MATERIALS AND METHODS A retrospective study was performed among 5850 patients who had an FDG-PT/CT scan from July 2015 to July 2018. Among these patients, we identified patients with a PET/CT description of incidental colorectal FDG uptake, and a colonoscopy within 90 days from the PET/CT scan. PET/CT findings were compared with colonoscopy-detected lesions and eventually histopathology on a per-lesion analysis and a per-person analysis. RESULTS A total of 145 patients were included in the study. A total of 180 foci of colorectal FDG uptake were detected on FDG-PET/CT. Of these, 86 foci corresponded to advanced colorectal neoplasia (ACRN), positive predictive value (PPV) 47.8%; 95% CI: 40.5-55.1%). On a per-patient analysis 81 patients had a least one ACRN at colonoscopy (PPV 55.9%; 95% CI: 47.6-63.8), this group included 20 patients (13.8%) diagnosed with cancer. There was a small positive correlation between focal FDG-uptake and the finding of ACRN at the same colonic segment at colonoscopy, which was statistically significant, rho = 0.2565, p = .002. The findings changed patient management in 67 (46.2%) cases. CONCLUSIONS Incidental focal colorectal FDG uptake on PET/CT is associated with a high risk of ACRN and is affecting subsequent patient management. Further evaluation with colonoscopy is recommended when the patient is considered suitable for further treatment.
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Affiliation(s)
| | - Claudia Jaensch
- Surgical Research Department, Regional Hospital West, Herning, Denmark
| | | | - Jørn Teil
- Department of Nuclear Medicine, Regional Hospital West, Herning, Denmark
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Moussaddaq AS, Brochard C, Palard-Novello X, Garin E, Wallenhorst T, Le Balc’h E, Merlini L’heritier A, Grainville T, Siproudhis L, Lièvre A. Incidental anal 18fluorodeoxyglucose uptake: Should we further examine the patient? World J Clin Cases 2020; 8:3679-3690. [PMID: 32953844 PMCID: PMC7479548 DOI: 10.12998/wjcc.v8.i17.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/15/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are no studies on incidental anal 18F-fluorodeoxyglucose (18FDG) uptake.
AIM To assess the rate and aetiologies of incidental anal 18FDG uptake and to evaluate the correlation between 18FDG positron-emission tomography/computed tomography (PET/CT) parameters and the diagnosis of an anorectal disease.
METHODS The data from patients with incidental anal 18FDG uptake were retrospectively analysed. Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations. Patients who were offered treatment were then identified and compared to those who did not receive treatment.
RESULTS Among the 43020 18FDG PET/CT scans performed, 197 18FDG PET/CT scans of 146 patients (0.45%) reported incidental anal uptake. Among the 134 patients included, 48 (35.8%) patients underwent anorectal examinations, and anorectal diseases were diagnosed in 33 (69.0%) of these patients and treated in 18/48 (37.5%) patients. Among the examined patients, those with a pathology requiring treatment had significantly smaller metabolic volumes (MV) 30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment.
CONCLUSION Incidental anal 18FDG uptake is rare, but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed. The diagnosis of an anorectal disease induces treatment in more than one-third of the patients. These data should encourage practitioners to explore incidental anal 18FDG uptake systematically.
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Affiliation(s)
- Anne-Sophie Moussaddaq
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Charlène Brochard
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
- Laboratoire Traitement du Signal et de l'Image-UMR1099, University of Rennes, Inserm, Rennes 35000, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Eric Le Balc’h
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | | | - Thomas Grainville
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Laurent Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Astrid Lièvre
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
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Abstract
The use of 18F-fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET/CT) is well established in the evaluation of alimentary tract malignancies. This review of the literature and demonstration of correlative images focuses on the current role of PET/CT in the diagnosis (including pathologic/clinical staging) and post-therapy follow-up of esophageal, gastric, and colorectal cancers. PET/CT provides utility in the management of esophageal cancer, including detection of distant disease prior to resection. In gastric cancer, PET/CT is useful in detecting solid organ metastases and in characterizing responders vs. non-responders after neoadjuvant chemotherapy, the latter of which have poorer overall survival. In patients with GIST tumors, PET/CT also determines response to imatinib therapy with greater expedience as compared to CECT. For colorectal cancer, PET/CT has proven helpful in detecting hepatic and other distant metastases, treatment response, and differentiating post-radiation changes from tumor recurrence. Our review also highlights several pitfalls in PET/CT interpretation of alimentary tract lesions.
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