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Karaalioglu B, Cakir T, Kutlu Y, Seker M, Bilici A. Integrated FDG-PET/CT contribution over cross-sectional imaging in recurrence or progression of pancreaticobiliary neoplasms. Abdom Radiol (NY) 2024; 49:131-140. [PMID: 37991533 DOI: 10.1007/s00261-023-04109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 03/20/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE We aim to compare FDG-PET/CT and cross-sectional imaging (contrastenhanced CT/MRI) diagnostic abilities in detecting recurrence/progression of pancreaticobiliary system tumors and to reveal the clinical impact of integrated FDGPET/CT to CT/MRI on patient management. MATERIALS AND METHODS FDG-PET/CT and CT/MRI scans of 70 patients from initiation of treatment until proven recurrence/progression were retrospectively evaluated. FDGPET/CT and contrast-enhanced CT/MRI accuracy, sensitivity, specificity, PPV and NPV are compared in terms of overall recurrence/progression diagnosis and sitespecific concern; local disease, local lymph node, and distant organ metastasis. The impact of integrated FDG-PET/CT on patient management is scrutinized. RESULTS CT/MRI has higher sensitivity than FDG-PET/CT in detecting loco-regional involvement (90% vs 76.7% P: 0.152), local lymph node metastasis (88.9% vs 77.8%, P: 0.380) and distant organ metastasis (96.5% vs 80.7%; P: 0.006) in tumor recurrence/progression. In overall diagnosis, CT/MRI is more sensitive and accurate but less specific than FDG-PET/CT (92.3% vs 87.7%; 87.1% vs 84.2%; 40% vs 20%, respectively). In 8% (6/70) of patients FDG-PET/CT had a major impact on patient management. CONCLUSION FDG-PET/CT and cross-sectional imaging have different advantages and shortcomings. In recurrence/progression, recognition of early changes is more feasible by CT/MRI. However, inconsistency of morphologic and metabolic findings is important reason of cross-sectional imaging failure. FDG-PET/CT is superior in showing extraabdominal metastases, but missing small-volume lesions and misinterpreting inflammatory changes are still a problem lowering its sensitivity. Nevertheless FDGPET/CT is good option for guiding undetermined imaging findings or clinic-radiologic mismatch.
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Affiliation(s)
- Banu Karaalioglu
- Department of Radiology, İstanbul Medipol University Hospital, İstanbul, Turkey.
| | - Tansel Cakir
- Department of Nuclear Medicine, İstanbul Medipol University Hospital, İstanbul, Turkey
| | - Yasin Kutlu
- Department of Clinical Oncology, İstanbul Medipol University Hospital, İstanbul, Turkey
| | - Mehmet Seker
- Department of Radiology, İstanbul Medipol University Hospital, İstanbul, Turkey
| | - Ahmet Bilici
- Department of Clinical Oncology, İstanbul Medipol University Hospital, İstanbul, Turkey
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2
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Pang L, Mao W, Zhang Y, Liu G, Hu P, Chen S, Gu Y, Wang Y, Liu H, Shi H. Comparison of 18F-FDG PET/MR and PET/CT for pretreatment TNM staging of hilar cholangiocarcinoma. Abdom Radiol (NY) 2023; 48:2537-2546. [PMID: 37179282 DOI: 10.1007/s00261-023-03925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE 18F-FDG PET/MR has been applied to the diagnosis and preoperative staging in various tumor types; however, reports using PET/MR in hilar cholangiocarcinoma (HCCA) are rare. We investigated the value of PET/MR for preoperative staging and compared it with PET/CT in HCCA. METHODS Fifty-eight patients with HCCA confirmed by pathology were retrospectively analyzed. 18F-FDG PET/CT imaging was performed first, followed with whole-body PET/MR imaging. SUVmax of tumor and normal liver tissue were measured. Paired T test was used to compare SUVmax of tumor and normal liver tissue of PET/CT and PET/MR. In addition, McNemar test was used to compare the accuracy of TNM staging and Bismuth-Corlette typing between PET/CT and PET/MR. RESULTS There was no significant difference in SUVmax between PET/CT and PET/MR in primary tumor lesions (6.6 ± 5.5 vs. 6.8 ± 6.2, P = 0.439). SUVmax of PET/CT and PET/MR in normal liver parenchyma was significantly different (3.0 ± 0.5 vs. 2.1 ± 0.5, P < 0.001). The accuracy of PET/MR in diagnosing T staging and N staging was significantly higher than those of PET/CT (72.4% vs. 58.6%, P = 0.022 and 84.5% vs. 67.2%, P = 0.002). There was no significant difference between PET/CT and PET/MR in M staging (94.8% vs. 98.3%, P = 0.5). The classification accuracy of PET/MR in Bismuth-Corlette was significantly higher than that of PET/CT (89.7% vs. 79.3%), P = 0.031. CONCLUSIONS The diagnostic accuracy of 18F-FDG PET/MR was superior to that of PET/CT in preoperative T staging, N staging, and Bismuth-Corlette classification of HCCA. In M staging, the diagnostic accuracy of PET/MR was similar to that of PET/CT.
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Affiliation(s)
- Lifang Pang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wujian Mao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengcheng Hu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shuguang Chen
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
| | - Yushen Gu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
| | - Yueqi Wang
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China
- Biliary Tract Diseases Institute, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Houbao Liu
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China.
- Biliary Tract Diseases Institute, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China.
- General Surgery Department, Zhongshan-Xuhui Hospital Affiliated to Fudan University, No. 966, Middle Huaihai Rd, Shanghai, 200031, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, People's Republic of China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China.
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Alvaro D, Gores GJ, Walicki J, Hassan C, Sapisochin G, Komuta M, Forner A, Valle JW, Laghi A, Ilyas SI, Park JW, Kelley RK, Reig M, Sangro B. EASL-ILCA Clinical Practice Guidelines on the management of intrahepatic cholangiocarcinoma. J Hepatol 2023; 79:181-208. [PMID: 37084797 DOI: 10.1016/j.jhep.2023.03.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/23/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) develops inside the liver, between bile ductules and the second-order bile ducts. It is the second most frequent primary liver cancer after hepatocellular carcinoma, and its global incidence is increasing. It is associated with an alarming mortality rate owing to its silent presentation (often leading to late diagnosis), highly aggressive nature and resistance to treatment. Early diagnosis, molecular characterisation, accurate staging and personalised multidisciplinary treatments represent current challenges for researchers and physicians. Unfortunately, these challenges are beset by the high heterogeneity of iCCA at the clinical, genomic, epigenetic and molecular levels, very often precluding successful management. Nonetheless, in the last few years, progress has been made in molecular characterisation, surgical management, and targeted therapy. Recent advances together with the awareness that iCCA represents a distinct entity amongst the CCA family, led the ILCA and EASL governing boards to commission international experts to draft dedicated evidence-based guidelines for physicians involved in the diagnostic, prognostic, and therapeutic management of iCCA.
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Cerrito L, Ainora ME, Borriello R, Piccirilli G, Garcovich M, Riccardi L, Pompili M, Gasbarrini A, Zocco MA. Contrast-Enhanced Imaging in the Management of Intrahepatic Cholangiocarcinoma: State of Art and Future Perspectives. Cancers (Basel) 2023; 15:3393. [PMID: 37444503 DOI: 10.3390/cancers15133393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) represents the second most common liver cancer after hepatocellular carcinoma, accounting for 15% of primary liver neoplasms. Its incidence and mortality rate have been rising during the last years, and total new cases are expected to increase up to 10-fold during the next two or three decades. Considering iCCA's poor prognosis and rapid spread, early diagnosis is still a crucial issue and can be very challenging due to the heterogeneity of tumor presentation at imaging exams and the need to assess a correct differential diagnosis with other liver lesions. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) plays an irreplaceable role in the evaluation of liver masses. iCCA's most typical imaging patterns are well-described, but atypical features are not uncommon at both CT and MRI; on the other hand, contrast-enhanced ultrasound (CEUS) has shown a great diagnostic value, with the interesting advantage of lower costs and no renal toxicity, but there is still no agreement regarding the most accurate contrastographic patterns for iCCA detection. Besides diagnostic accuracy, all these imaging techniques play a pivotal role in the choice of the therapeutic approach and eligibility for surgery, and there is an increasing interest in the specific imaging features which can predict tumor behavior or histologic subtypes. Further prognostic information may also be provided by the extraction of quantitative data through radiomic analysis, creating prognostic multi-parametric models, including clinical and serological parameters. In this review, we aim to summarize the role of contrast-enhanced imaging in the diagnosis and management of iCCA, from the actual issues in the differential diagnosis of liver masses to the newest prognostic implications.
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Affiliation(s)
- Lucia Cerrito
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Elena Ainora
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Borriello
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulia Piccirilli
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Laura Riccardi
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maurizio Pompili
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Gnanasegaran G, Agrawal K, Wan S. 18F-Fluorodeoxyglucose-PET-Computerized Tomography and non-Fluorodeoxyglucose PET-Computerized Tomography in Hepatobiliary and Pancreatic Malignancies. PET Clin 2022; 17:369-388. [PMID: 35717098 DOI: 10.1016/j.cpet.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Molecular imaging with PET-computerized tomography (PET-CT) plays an important role in oncology. There is current and evolving evidence supporting the use of fluorodeoxyglucose (FDG) and non-FDG tracers in assessment patients with hepatobiliary and pancreatic cancers in various clinical scenarios. In this chapter, we discuss the advantages and limitations of FDG and non-FDG PET-CT in the management of patients with hepatobiliary and pancreatic cancers.
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Affiliation(s)
| | | | - Simon Wan
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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6
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Imaging Features of Main Posthepatectomy Complications: A Radiologist’s Challenge. Diagnostics (Basel) 2022; 12:diagnostics12061323. [PMID: 35741133 PMCID: PMC9221607 DOI: 10.3390/diagnostics12061323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
In the recent years, the number of liver resections has seen an impressive growth. Usually, hepatic resections remain the treatment of various liver diseases, such as malignant tumors, benign tumors, hydatid disease, and abscesses. Despite technical advancements and tremendous experience in the field of liver resection of specialized centers, there are moderately high rates of postoperative morbidity and mortality, especially in high-risk and older patient populations. Although ultrasonography is usually the first-line imaging examination for postoperative complications, Computed Tomography (CT) is the imaging tool of choice in emergency settings due to its capability to assess the whole body in a few seconds and detect all possible complications. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for delineating early postoperative bile duct injuries and ischemic cholangitis that may arise in the late postoperative phase. Moreover, both MDCT and MRCP can precisely detect tumor recurrence. Consequently, radiologists should have knowledge of these surgical procedures for better comprehension of postoperative changes and recognition of the radiological features of various postoperative complications.
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7
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Yang CM, Shu J. Cholangiocarcinoma Evaluation via Imaging and Artificial Intelligence. Oncology 2020; 99:72-83. [PMID: 33147583 DOI: 10.1159/000507449] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cholangiocarcinoma (CCA) is a relatively rare malignant biliary system tumor, and yet it represents the second most common primary hepatic neoplasm, following hepatocellular carcinoma. Regardless of the type, location, or etiology, the survival prognosis of these tumors remains poor. The only method of cure for CCA is complete surgical resection, but part of patients with complete resection are still subject to local recurrence or distant metastasis. SUMMARY Over the last several decades, our understanding of the molecular biology of CCA has increased tremendously, diagnostic and evaluative techniques have evolved, and novel therapeutic approaches have been established. Key Messages: This review provides an overview of preoperative imaging evaluations of CCA. Furthermore, relevant information about artificial intelligence (AI) in medical imaging is discussed, as well as the development of AI in CCA treatment.
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Affiliation(s)
- Chun Mei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China,
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Saleh M, Virarkar M, Bura V, Valenzuela R, Javadi S, Szklaruk J, Bhosale P. Intrahepatic cholangiocarcinoma: pathogenesis, current staging, and radiological findings. Abdom Radiol (NY) 2020; 45:3662-3680. [PMID: 32417933 DOI: 10.1007/s00261-020-02559-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To this date, it is a major oncological challenge to optimally diagnose, stage, and manage intrahepatic cholangiocarcinoma (ICC). Imaging can not only diagnose and stage ICC, but it can also guide management. Hence, imaging is indispensable in the management of ICC. In this article, we review the pathology, epidemiology, genetics, clinical presentation, staging, pathology, radiology, and treatment of ICC.
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9
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Ozaki K, Harada K, Terayama N, Kosaka N, Kimura H, Gabata T. FDG-PET/CT imaging findings of hepatic tumors and tumor-like lesions based on molecular background. Jpn J Radiol 2020; 38:697-718. [PMID: 32246350 DOI: 10.1007/s11604-020-00961-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The usefulness of whole-body 18-fluoro-2-deoxyglucose (FDG)-fluorodeoxyglucose positron emission (PET)/computed tomography (CT) is established for assessment of disease staging, detection of early disease recurrence, therapeutic evaluation, and predicting prognosis in various malignancies; and for evaluating the spread of inflammation. However, the role of FDG-PET/CT for the liver is limited because CT and magnetic resonance imaging (MRI) can provide an accurate diagnosis of most tumors. In addition, in other potentially useful roles there are several pitfalls in the interpretation of FDG uptake in PET/CT imaging. Accurate evaluation demands knowledge of the FDG uptake of each lesion, including potential negative and positive uptakes, and requires an understanding of the underlying background of the molecular mechanisms. The degree of FDG uptake is dependent on cellular metabolic rate and the expression of glucose transporter, hexokinase, and glucose-6-phosphatase, which in turn are closely affected by biological characteristics such as pathological category (e.g., adenocarcinoma, squamous cell carcinoma, small cell cancer, transitional cell cancer, neuroendocrine tumor, sarcoma, lymphoma), tumor differentiation, histological behavior (e.g., solid, cystic, mucinous), and intratumoral alterations (e.g., necrosis, degeneration, hemorrhage). Correlation with the CT and MRI findings, which also precisely depict the pathological findings, is important to avoid misdiagnosis.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kenichi Harada
- Department of Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Noboru Terayama
- Department of Radiology, Takaoka City Hospital, Takaoka, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Lamarca A, Frizziero M, McNamara MG, Valle JW. Clinical and Translational Research Challenges in Biliary Tract Cancers. Curr Med Chem 2020; 27:4756-4777. [PMID: 31971102 DOI: 10.2174/0929867327666200123090153] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biliary Tract Cancers (BTC) are rare malignancies with a poor prognosis. There are many challenges encountered in treating these patients in daily practice as well as in clinical, translational and basic research. OBJECTIVE This review summarises the most relevant challenges in clinical and translational research in BTCs and suggests potential solutions towards an improvement in quality of life and outcomes of patients diagnosed with such malignancies. FINDINGS The main challenge is the low number of patients with BTCs, complicated by the aggressive natural behaviour of cancer and the lack of funding sources for research. In addition, the clinical characteristics of these patients and the specific cancer-related complications challenge clinical research and clinical trial recruitment. It is worth highlighting that BTCs are a group of different malignancies (cholangiocarcinoma, gallbladder cancer and ampullary cancer) rather than a unique homogeneous disease. These subgroups differ not only in molecular aspects, but also in clinical and demographic characteristics. In addition, tailored imaging and quality of life assessment are required to tackle some of the issues specific to BTCs. Finally, difficulties in tissue acquisition both in terms of biopsy size and inclusion of sufficient tumour within the samples, may adversely impact translational and basic research. CONCLUSION Increasing awareness among patients and clinicians regarding BTC and the need for further research and treatment development may address some of the main challenges in BTC research. International collaboration is mandatory to progress the field.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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11
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Lamarca A, Barriuso J, Chander A, McNamara MG, Hubner RA, ÓReilly D, Manoharan P, Valle JW. 18F-fluorodeoxyglucose positron emission tomography ( 18FDG-PET) for patients with biliary tract cancer: Systematic review and meta-analysis. J Hepatol 2019; 71:115-129. [PMID: 30797051 DOI: 10.1016/j.jhep.2019.01.038] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The role of 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) in the diagnosis and staging of patients with biliary tract cancers (BTCs) remains controversial, so we aimed to provide robust information on the utility of 18FDG-PET in the diagnosis and management of BTC. METHODS This systematic review and meta-analysis explored the diagnostic test accuracy of 18FDG-PET as a diagnostic tool for diagnosis of primary tumour, lymph node invasion, distant metastases and relapsed disease. Subgroup analysis by study quality and BTC subtype were performed. Changes in management based on 18FDG-PET and impact of maximum standardised uptake values (SUVmax) on prognosis were also assessed. A random effects model was used for meta-analyses. RESULTS A total of 2,125 patients were included from 47 eligible studies. The sensitivity (Se) and specificity (Sp) of 18FDG-PET for the diagnosis of primary tumour were 91.7% (95% CI 89.8-93.2) and 51.3% (95% CI 46.4-56.2), respectively, with an area under the curve (AUC) of 0.8668. For lymph node invasion, Se was 88.4% (95% CI82.6-92.8) and Sp was 69.1% (95% CI 63.8-74.1); AUC 0.8519. For distant metastases, Se was 85.4% (95% CI 79.5-90.2) and Sp was 89.7% (95% CI86.0-92.7); AUC 0.9253. For relapse, Se was 90.1% (95% CI 84.4-94.3) and Sp was 83.5% (95% CI 74.4-90.4); AUC 0.9592. No diagnostic threshold effect was identified. Meta-regression did not identify significant sources of heterogeneity. Sensitivity analysis revealed no change in results when analyses were limited to studies with low risk of bias/concern. The pooled proportion of change in management was 15% (95% CI 11-20); the majority (78%) due to disease upstaging. Baseline high SUVmax was associated with worse survival (pooled hazard ratio of 1.79; 95% CI 1.37-2.33; p <0.001). CONCLUSIONS There is evidence to support the incorporation of 18FDG-PET into the current standard of care for the staging (lymph node and distant metastases) and identification of relapse in patients with BTC to guide treatment selection; especially if the identification of occult sites of disease would change management, or if diagnosis of relapse remains unclear following standard of care imaging. The role for diagnosis of the primary tumour remains controversial due to low sensitivity and 18FDG-PET should not be considered as a replacement for pathological confirmation in this setting. LAY SUMMARY A positron emission tomography (PET scan), using 18F-fluorodeoxyglucose (18FDG), can help doctors identify areas of cancer in the body by highlighting "hot spots". These hotspots may be cancerous (true positive) but may also be non-cancerous, like inflammation (false positive). We show that PET scans are useful to assess how far advanced the cancer is (by assessing spread to lymph glands and to other organs) and also to identify if the cancer has recurred (for example after surgery), thus helping doctors to make treatment decisions. However, a biopsy is still needed for the initial diagnosis of a biliary tract cancer, because of the high chance of a "false positive" with PET scans.
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Affiliation(s)
- Angela Lamarca
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK.
| | - Jorge Barriuso
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Amarjot Chander
- Radiology and Nuclear Medicine Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Mairéad G McNamara
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Richard A Hubner
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Derek ÓReilly
- HPB Surgery Department, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK
| | - Prakash Manoharan
- Radiology and Nuclear Medicine Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Juan W Valle
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK.
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Abstract
Cholangiocarcinomas (CC) are rare tumors which usually present late and are often difficult to diagnose and treat. CCs are categorized as intrahepatic, hilar, or extrahepatic. Epidemiologic studies suggest that the incidence of intrahepatic CCs may be increasing worldwide. In this chapter, we review the risk factors, clinical presentation, and management of cholangiocarcinoma.
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Kim E, Kim YJ, Kim K, Song C, Kim JS, Oh DY, Nam EM, Chie EK. Salvage radiotherapy for locoregionally recurrent extrahepatic bile duct cancer after radical surgery. Br J Radiol 2017; 90:20170308. [PMID: 28937265 DOI: 10.1259/bjr.20170308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study evaluated the outcome of salvage radiotherapy for locoregionally recurrent extrahepatic bile duct cancer. METHODS We performed a retrospective review of 23 extrahepatic bile duct cancer patients who underwent radiotherapy with or without concomitant chemotherapy for isolated locoregional recurrence after radical surgery between August 2001 and September 2013. The median disease-free interval was 11.8 months. Salvage radiotherapy was delivered to the recurrent tumour with or without initial operation bed up to a median dose of 54 Gy (range, 45-60). 18 patients received concomitant chemotherapy. RESULTS The median follow-up period was 14.2 months for all patients, and 48.8 months for survivors. The median overall survival and progression-free survival (PFS) were 18.4 (range, 4.4-114.6) and 15.5 months (range, 1.6-114.6), respectively. On multivariate analysis, the use of concomitant chemotherapy was a favourable prognostic factor for PFS (p = 0.027), and prolonged disease-free interval (≥1 year) was associated with a significantly poor overall survival (p = 0.047). Grade 3 or higher toxicities did not occur in follow-up period. CONCLUSION Salvage radiotherapy showed promising survival outcomes in locoregional recurrence of extrahepatic bile duct cancer. Our results indicated that concomitant chemotherapy was associated with improved PFS. Concurrent chemoradiotherapy can be a viable salvage treatment option in selected patients. Advances in knowledge: Locoregional recurrence is the most common pattern of failure after radical resection in extrahepatic bile duct cancer. In this study, salvage radiotherapy showed favourable survival outcomes without severe complications in locoregionally recurrent extrahepatic bile duct cancer patients.
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Affiliation(s)
- Eunji Kim
- 1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yi-Jun Kim
- 2 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- 2 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Changhoon Song
- 3 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jae-Sung Kim
- 3 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Do-Youn Oh
- 4 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Nam
- 5 Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Eui Kyu Chie
- 1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
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14
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Hu JH, Tang JH, Lin CH, Chu YY, Liu NJ. Preoperative staging of cholangiocarcinoma and biliary carcinoma using 18F-fluorodeoxyglucose positron emission tomography: a meta-analysis. J Investig Med 2017; 66:52-61. [DOI: 10.1136/jim-2017-000472] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 02/06/2023]
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15
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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16
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Oliveira IS, Kilcoyne A, Everett JM, Mino-Kenudson M, Harisinghani MG, Ganesan K. Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management. Abdom Radiol (NY) 2017; 42:1637-1649. [PMID: 28271275 DOI: 10.1007/s00261-017-1094-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is a relatively uncommon malignant neoplasm with poor prognosis. The distinction between extrahepatic and intrahepatic subtypes is important as epidemiological features, biologic and pathologic characteristics, and clinical course are different for both entities. This review study focuses on the role imaging plays in the diagnosis, classification, staging, and post-treatment assessment of cholangiocarcinoma.
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Affiliation(s)
- Irai S Oliveira
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP, 01308-050, Brazil.
| | - Aoife Kilcoyne
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jamie M Everett
- Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN - Reliance Foundation Hospital, Mumbai, 400004, India
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17
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Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M. Imaging of Cholangiocarcinoma. Visc Med 2016; 32:402-410. [PMID: 28229074 DOI: 10.1159/000453009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cholangiocarcinoma (CC) is the second most common primary hepatobiliary tumour, and it is increasing in incidence. Imaging characteristics, behaviour, and therapeutic strategies in CC differ significantly, depending on the morphology and location of the tumour. In cross-sectional imaging, CCs can be classified according to the growth pattern (mass-forming, periductal infiltrating, intraductal) and the location (intrahepatic, perihilar, extrahepatic/distal). The prognosis of CC is unfavourable and surgical resection is the only curative treatment option; thus, early diagnosis (also in recurrent disease) and accurate staging including the evaluation of lymph node involvement and vascular infiltration is crucial. However, the diagnostic evaluation of CC is challenging due to the heterogeneous nature of the tumour. Diagnostic modalities used in the imaging of CC include transabdominal ultrasound, endosonography, computed tomography, magnetic resonance imaging with cholangiopancreatography, and hybrid imaging such as positron emission tomography/computed tomography. In this review, the potential of cross-sectional imaging modalities in primary staging, treatment monitoring, and detection of recurrent disease will be discussed.
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Affiliation(s)
- Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Christina Schraml
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Malte Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
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18
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Ronot M, Clift AK, Vilgrain V, Frilling A. Functional imaging in liver tumours. J Hepatol 2016; 65:1017-1030. [PMID: 27395013 DOI: 10.1016/j.jhep.2016.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/08/2023]
Abstract
Functional imaging encompasses techniques capable of assessing physiological parameters of tissues, and offers useful clinical information in addition to that obtained from morphological imaging. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. The liver is of major importance in oncological practice; not only is hepatocellular carcinoma one of the malignancies with steadily rising incidence worldwide, but hepatic metastases are regularly observed with a range of solid neoplasms. Within the realm of hepatic oncology, different functional imaging modalities may occupy pivotal roles in lesion characterisation, treatment selection and follow-up, depending on tumour size and type. In this review, we characterise the major forms of functional imaging, discuss their current application to the management of patients with common primary and secondary liver tumours, and anticipate future developments within this field.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | | | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
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19
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Abstract
PET/computed tomography (PET/CT) is an established hybrid imaging technique for staging and follow-up of gastrointestinal (GI) tract malignancies, especially for colorectal carcinoma. Dedicated hybrid PET/MR imaging scanners are currently available for clinical use. Although they will not replace regular use of PET/CT, they may have utility in selected cases of GI tract malignancies. The superior soft tissue contrast resolution and depiction of anatomy and the functional information obtained from diffusion-weighted imaging (DWI) provided by MR imaging in PET/MR imaging are advantages over CT of PET/CT for T staging and follow-up of rectal carcinoma and for better characterization of liver lesions. Functional information from DWI and use of liver-specific MR imaging contrast agents are an added advantage in follow-up of liver metastases after systemic and locoregional treatment. New radiotracers will improve the utility of PET/MR imaging in staging and follow-up of tumors, which may not be [18F]-2-fluoro-2-deoxy-d-glucose avid, such as hepatocellular carcinoma and neuroendocrine tumors. PET/MR imaging also has application in selected cases of cholangiocarcinoma, gallbladder cancer, and pancreatic carcinoma for initial staging and follow-up assessment.
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Affiliation(s)
- Raj Mohan Paspulati
- Division of Abdominal Imaging, Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Amit Gupta
- Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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20
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Mulé S, Colosio A, Cazejust J, Kianmanesh R, Soyer P, Hoeffel C. Imaging of the postoperative liver: review of normal appearances and common complications. ACTA ACUST UNITED AC 2016; 40:2761-76. [PMID: 26023007 DOI: 10.1007/s00261-015-0459-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several benign and malignant liver diseases may require surgical treatment for cure, including anatomical resections based on the segmental anatomy of the liver, non-anatomical (wedge) resections, and surgical management of biliary cysts. The type of surgery depends not only on the location and the nature of the disease, but also on the expertise of the surgeon. Whereas ultrasonography is often the first-line imaging examination in case of suspected postoperative complication, multidetector computed tomography (MDCT) is of greater value for identifying normal findings after surgery, early postoperative pathologic fluid collections and vascular thromboses, and tumor recurrence in patients who have undergone hepatic surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for depicting early postoperative bile duct injuries and ischemic cholangitis that may occur in the late postoperative phase. Both MDCT and MRCP can accurately depict tumor recurrence. Radiologists should become familiar with these surgical procedures to better understand postoperative changes, and with the normal imaging appearances of various postoperative complications to better differentiate between complications and normal findings.
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Affiliation(s)
- S Mulé
- Department of Radiology, Reims University Hospital, 45, rue Cognacq-Jay, 51092, Reims Cedex, France.
| | - A Colosio
- Department of Radiology, Reims University Hospital, 45, rue Cognacq-Jay, 51092, Reims Cedex, France
| | - J Cazejust
- Department of Radiology, Saint-Antoine University Hospital, 184, rue du Faubourg-Saint-Antoine, 75012, Paris, France
| | - R Kianmanesh
- Department of Digestive and Endocrine Surgery, Reims University Hospital, 45, rue Cognacq-Jay, 51092, Reims Cedex, France
| | - P Soyer
- Department of Abdominal Imaging, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, 10 rue de Verdun, 75010, Paris, France
| | - C Hoeffel
- Department of Radiology, Reims University Hospital, 45, rue Cognacq-Jay, 51092, Reims Cedex, France
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21
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Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
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Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
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22
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Abstract
(18)Fluorine-2-fluoro-2-Deoxy-d-glucose ((18)F-FDG) positron emission tomography/computerized tomography (PET/CT) is a well-established functional imaging method widely used in oncology. In this article, we have incorporated the various indications for (18)FDG PET/CT in oncology based on available evidence and current guidelines. Growing body of evidence for use of (18)FDG PET/CT in select tumors is also discussed. This article attempts to give the reader an overview of the appropriateness of using (18)F-FDG PET/CT in various malignancies.
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Affiliation(s)
- Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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23
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Ringe KI, Wacker F. Radiological diagnosis in cholangiocarcinoma: Application of computed tomography, magnetic resonance imaging, and positron emission tomography. Best Pract Res Clin Gastroenterol 2015; 29:253-65. [PMID: 25966426 DOI: 10.1016/j.bpg.2015.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/07/2015] [Indexed: 01/31/2023]
Abstract
The purpose of radiological imaging in patients with suspected or known cholangiocarcinoma (CCA) is tumour detection, lesion characterization and assessment of resectability. Different imaging modalities are implemented complementary in the diagnostic work-up. Non-invasive imaging should be performed prior to invasive biliary procedures in order to avoid false positive results. For assessment of intraparenchymal tumour extension and evaluation of biliary and vascular invasion, MRI including MRCP and CT are the primarily used imaging modalities. The role of PET remains controversial with few studies showing benefit with the detection of unexpected metastatic spread, the differentiation between benign and malignant biliary strictures, and for discriminating post therapeutic changes and recurrent CCA.
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Affiliation(s)
- Kristina I Ringe
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Frank Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Carl-Neuberg Str. 1, 30625 Hannover, Germany
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24
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Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: A review. World J Radiol 2015; 7:28-44. [PMID: 25729485 PMCID: PMC4326732 DOI: 10.4329/wjr.v7.i2.28] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/14/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in the form of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions.
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25
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Lubezky N, Facciuto M, Harimoto N, Schwartz ME, Florman SS. Surgical treatment of intrahepatic cholangiocarcinoma in the USA. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:124-30. [PMID: 25187408 DOI: 10.1002/jhbp.157] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cholangiocarcinoma (CC) is a malignancy that arises from the epithelial cells of the biliary system (ductules as well as large ducts, and likely from progenitor cells, as well). Intrahepatic CC (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma (HCC), and accounts for 10-15% of primary liver cancers. ICC differs from both extrahepatic and CC and HCC and has unique risk factors, histological features, genetic alterations and clinical outcomes. The natural history and results of surgical intervention are not well described as ICC is a relatively uncommon tumor, especially in the USA. This article reviews the literature relevant to the surgical management and outcome of patients with ICC in the USA.
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Affiliation(s)
- Nir Lubezky
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, 1 Gustave Levy Place, Box 1104, New York, NY, 10029, USA
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26
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Abstract
This review article is focused on the role of FDG PET/CT in diagnosing and characterizing hepatic incidentalomas. A large variety of unsuspected lesions can be detected in the liver both with ultrasound and CT performed for other reasons; the prevalence of liver incidentalomas increases in patients with chronic liver disease or preexisting oncologic history. The major challenge is to discriminate benign from malignant lesions. There is a large body of literature indicating that FDG PET/CT is a useful tool to this purpose even if it is unspecific (ie, it cannot differentiate a primary tumor from a secondary lesion). Occasionally, FDG PET/CT can be useful for biopsy guidance.
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27
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Eo JS, Paeng JC, Lee DS. Nuclear imaging for functional evaluation and theragnosis in liver malignancy and transplantation. World J Gastroenterol 2014; 20:5375-5388. [PMID: 24833867 PMCID: PMC4017052 DOI: 10.3748/wjg.v20.i18.5375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/23/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. 18F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as 11C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.
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28
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29
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FDG and other radiopharmaceuticals in the evaluation of liver lesions. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Tsurusaki M, Okada M, Kuroda H, Matsuki M, Ishii K, Murakami T. Clinical application of 18F-fluorodeoxyglucose positron emission tomography for assessment and evaluation after therapy for malignant hepatic tumor. J Gastroenterol 2014; 49:46-56. [PMID: 23525980 PMCID: PMC3895191 DOI: 10.1007/s00535-013-0790-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/04/2013] [Indexed: 02/04/2023]
Abstract
Positron emission tomography (PET) is widely available and its application with 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors, and monitoring the therapeutic efficacy in hepatic malignancies. Recently, investigators have measured glucose utilization in liver tumors using (18)F-FDG and positron emission tomography/computer tomography (PET/CT) in order to establish a diagnosis of tumors, assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. The PET/CT with (18)F-FDG may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis, staging, restaging and evaluating its biological characteristics, which can benefit the patients suffering from primary and metastatic hepatic tumors such as hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and metastatic liver tumor.
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Affiliation(s)
- Masakatsu Tsurusaki
- Department of Diagnostic Radiology, Kinki University, School of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan,
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31
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Role of positron emission tomography-computed tomography in gastrointestinal malignancies. Radiol Clin North Am 2013; 51:799-831. [PMID: 24010907 DOI: 10.1016/j.rcl.2013.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Positron emission tomography (PET) has proved itself to be valuable in the evaluation of patients with a wide array of gastrointestinal (GI) malignancies. Subsequent development of fusion imaging with PET and computed tomography (PET-CT) scanners has significantly advanced the capabilities of imaging by combining the functional data of the(18)F-labeled glucose analogue fluorodeoxyglucose (FDG) with the conventional anatomic data provided by CT. This article reviews the evolving role of FDG PET-CT imaging in the initial assessment and monitoring of GI tumors. Specific applications are discussed, and normal variants and benign findings frequently encountered during PET-CT of the GI tract are reviewed.
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32
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Albazaz R, Patel CN, Chowdhury FU, Scarsbrook AF. Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours. Insights Imaging 2013; 4:691-700. [PMID: 23884572 PMCID: PMC3781255 DOI: 10.1007/s13244-013-0268-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/20/2013] [Accepted: 06/24/2013] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess the impact on clinical management of introducing 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-computed tomography (CT) in to the work-up of patients with primary and recurrent biliary malignancy. Methods Consecutive patients with primary biliary tumours undergoing FDG PET-CT at a single large tertiary referral centre between November 2007 and September 2010 were retrospectively analysed. Findings on FDG PET-CT compared with CT/magnetic resonance imaging (MRI) and impact on subsequent patient management were evaluated. Impact was divided into: (1) major—detection of occult disease or characterisation of indeterminate lesion(s) on CT/MRI; (2) minor—confirmation of suspected metastases seen on CT/MRI; (3) no impact. Results One hundred and eleven patients underwent 118 FDG PET-CT scans, including 30 with suspected gallbladder carcinoma and 81 with cholangiocarcinoma. Eighty-nine scans were performed for initial staging, five for restaging following neoadjuvant chemotherapy and 24 for suspected disease recurrence. In 33 cases (28 %), FDG PET-CT had a major impact on subsequent patient management (39 % gallbladder carcinoma, 26 % intrahepatic cholangiocarcinoma and 21 % extrahepatic cholangiocarcinoma). FDG PET-CT had a minor impact in 20 cases (17 %) and no impact in 65 cases (55 %). Conclusions By detecting occult metastatic disease and characterising indeterminate lesions, FDG PET-CT can have a major influence on clinical decision-making in primary and recurrent biliary malignancy.
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Affiliation(s)
- Raneem Albazaz
- Department of Radiology, Level 0, Bexley Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK,
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Sharma B, Martin A, Zerizer I. Positron Emission Tomography-Computed Tomography in Liver Imaging. Semin Ultrasound CT MR 2013; 34:66-80. [DOI: 10.1053/j.sult.2012.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Intérêt de l’imagerie fonctionnelle TEP dans les tumeurs hépatobiliaires primitives malignes. ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cameron K, Golan S, Simpson W, Peti S, Roayaie S, Labow D, Kostakoglu L. Recurrent pancreatic carcinoma and cholangiocarcinoma: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). ACTA ACUST UNITED AC 2011; 36:463-71. [PMID: 21465110 DOI: 10.1007/s00261-011-9729-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the current literature is limited, available data suggest that (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging improves the evaluation of patients with recurrent pancreatic carcinoma and cholangiocarcinoma. There is evidence that PET/CT is particularly useful in the setting of elevated tumor markers and negative or equivocal CT findings. This article reviews the nature of these carcinomas in the post-therapy setting and describes the strengths and limitations of PET/CT when used for monitoring recurrence.
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Affiliation(s)
- Katherine Cameron
- Department of Radiology, Mount Sinai Medical Center, New York, NY 10029, USA
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Value of PET/CT in the management of primary hepatobiliary tumors, part 2. AJR Am J Roentgenol 2011; 197:W260-5. [PMID: 21785051 DOI: 10.2214/ajr.11.6995] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Primary hepatobiliary malignancies consist of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder cancer. Benign hepatic lesions include hepatic cysts, hemagiomas, adenomas, and focal nodular hyperplasias. The utility of PET/CT in imaging primary hepatobiliary lesions varies according to the type and location of the lesion. CONCLUSION There is a consistent benefit to the use of PET/CT for detection and staging, and it ultimately helps to establish the best course of treatment and to determine prognosis. In addition, PET/CT is very useful in local ablative and systemic therapy assessment and surveillance for hepatobiliary malignancies.
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Lee YG, Han SW, Oh DY, Chie EK, Jang JY, Im SA, Kim TY, Kim SW, Ha SW, Bang YJ. Diagnostic performance of contrast enhanced CT and 18F-FDG PET/CT in suspicious recurrence of biliary tract cancer after curative resection. BMC Cancer 2011; 11:188. [PMID: 21599995 PMCID: PMC3120804 DOI: 10.1186/1471-2407-11-188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 05/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the late clinical presentation of biliary tract cancer (BTC), only 10% of patients are eligible for curative surgery. Even among those patients who have undergone curative surgery, most patients develop recurrent cancer. This study is to determine the clinical role of 18F-FDG PET/CT during post-operative surveillance of suspected recurrent BTC based on symptoms, laboratory findings and contrast-enhanced CT (ceCT) findings. METHODS We consecutively enrolled 50 patients with BTC who underwent curative surgery. An 18F-FDG PET/CT was obtained for assessment of recurrence based on clinical suspicion during post-operative surveillance. The final confirmation of recurrence was determined pathologically or clinically. When a pathologic confirmation was impossible or inconclusive, a clinical confirmation was used by radiologic correlation with subsequent follow-up ceCT at a minimum of 3-month intervals. Diagnostic efficacy was evaluated by comparing the results of ceCT and 18F-FDG PET/CT with the final diagnosis. RESULTS Among the 50 patients, 34(68%) were confirmed to have a recurrence. PET/CT showed higher sensitivity (88% vs. 76%, p=0.16) and accuracy (82% vs. 66%, p=0.11) for recurrence compared to ceCT, even though the difference was not significant. The positive (86% vs. 74%, p=0.72) and negative predictive values for recurrence (73% vs. 47%, p=0.55) were not significantly different between PET/CT and ceCT. However, an additional PET/CT on ceCT significantly improved the sensitivity than did a ceCT alone (94% [32/34] for PET/CT on ceCT vs. 76% [26/34] for ceCT alone, p=0.03) without increasing the specificity, positive predictive value, and negative predictive value. CONCLUSIONS 18F-FDG PET/CT alone is not more sensitive or specific than ceCT in the detection of recurrent BTC after curative surgery. These results do not reach statistical significance, probably due to the low number of patients. However, an additional 18F-FDG PET/CT on ceCT significantly improves the sensitivity of detecting recurrences.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Seoul National University Hospital, and Cancer Research Institute, Department of Molecular Medicine & Biopharmaceutical Sciences, Graduate School of Convergence, Seoul National University College of Medicine, Seoul, Republic of Korea
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Ruys AT, Bennink RJ, van Westreenen HL, Engelbrecht MR, Busch OR, Gouma DJ, van Gulik TM. FDG-positron emission tomography/computed tomography and standardized uptake value in the primary diagnosis and staging of hilar cholangiocarcinoma. HPB (Oxford) 2011; 13:256-62. [PMID: 21418131 PMCID: PMC3081626 DOI: 10.1111/j.1477-2574.2010.00280.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The diagnosis and staging of hilar cholangiocarcinoma (HCCA) remain challenging despite recent advances in imaging. Little is known about the use of positron emission tomography/computed tomography (PET/CT) in HCCA. OBJECTIVES This study aimed to evaluate the additional value of FDG-PET/CT and standardized uptake value (SUV) in patients with highly suspected HCCA. METHODS Between February 2006 and August 2009, PET/CT was performed in 30 patients with highly suspected HCCA, all of whom were deemed resectable by conventional staging methods, including laparoscopy. The results of PET-CT and SUV were compared with intraoperative and histopathological findings. RESULTS The primary tumour was (18) F-FDG-positive in 88% of patients. Sensitivity and specificity for the detection of regional lymph node metastases and distant metastases were 67% and 68%, and 33% and 96%, respectively. The median SUV in the primary tumour was significantly (P < 0.05) higher in patients with (mean: 8.9) than without (mean: 6.1) distant metastases. The SUV in patients with benign disease (n= 4) showed a trend towards lower values than in patients with cholangiocarcinoma, although this was not significant. CONCLUSIONS After conventional staging including diagnostic laparoscopy, the additional value of PET/CT is limited. This somewhat disappointing finding may reflect the fact that extensive staging studies were carried out prior to PET/CT. The SUV potentially predicts patients with distant metastases and may differentiate between HCCA and benign lesions that mimic malignancies.
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Affiliation(s)
- Anthony T Ruys
- Department of Surgery, University of AmsterdamAmsterdam, the Netherlands
| | - Roel J Bennink
- Department of Nuclear Medicine, University of AmsterdamAmsterdam, the Netherlands
| | | | - Marc R Engelbrecht
- Department of Radiology, Academic Medical Centre, University of AmsterdamAmsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, University of AmsterdamAmsterdam, the Netherlands
| | - Dirk J Gouma
- Department of Surgery, University of AmsterdamAmsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, University of AmsterdamAmsterdam, the Netherlands
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Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol 2010; 45:560-6. [PMID: 20035356 DOI: 10.1007/s00535-009-0188-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 12/07/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reports concerning the clinical usefulness of (18)F 2-fluoro-2-deoxy-D: -glucose integrated positron emission and computed tomography ((18)F-FDG PET-CT) for patients with gallbladder cancer and cholangiocarcinoma are relatively scarce. The purpose of this study was to assess the diagnostic value of PET-CT in relation to a conventional imaging modality, multidetector row CT (MDCT), for patients with gallbladder cancer and cholangiocarcinoma. METHODS Ninety-nine patients with suspected gallbladder cancer and cholangiocarcinoma who underwent both PET-CT and MDCT for initial staging were included in our study. The results of these two imaging modalities for evaluating primary tumors, regional lymph nodes and distant metastases were compared with the final diagnoses based on pathological or clinical findings. RESULTS A maximum standardized uptake value (SUV(max)) of 3.65 was found to be the best cutoff value for detecting a malignant tumor. The overall values for the sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs) and the accuracies of PET-CT and MDCT for the detection of a primary tumor were 90.2, 70.6, 93.7, 60.0, 86.9% and 84.2, 70.6, 93.2, 48.0, 81.8%, respectively. PET-CT demonstrated no significant advantage over MDCT for the diagnosis of a primary tumor. PET-CT showed a significantly higher PPV (94.1 vs. 77.5%, P = 0.04) than that found for MDCT in the diagnosis of regional lymph node metastasis. Additionally, PET-CT showed a significantly higher sensitivity (94.7 vs. 63.2%, P = 0.02) than that found for MDCT in the diagnosis of distant metastasis. CONCLUSIONS PET-CT is valuable for detecting regional lymph node involvement and unsuspected distant metastases that are not diagnosed by MDCT.
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Petrowsky H, Hong JC. Current surgical management of hilar and intrahepatic cholangiocarcinoma: the role of resection and orthotopic liver transplantation. Transplant Proc 2010; 41:4023-35. [PMID: 20005336 DOI: 10.1016/j.transproceed.2009.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cholangiocarcinoma (CCA) is a rare but devastating malignancy that presents late, is notoriously difficult to diagnose, and is associated with a high mortality. Surgical resection is the only chance for cure or long-term survival. The treatment of CCA has remained challenging because of the lack of effective adjuvant therapy, aggressive nature of the disease, and critical location of the tumor in close proximity to vital structures such as the hepatic artery and the portal vein. Moreover, the operative approach is dictated by the location of the tumor and the presence of underlying liver disease. During the past 4 decades, the operative management of CCA has evolved from a treatment modality that primarily aimed at palliation to curative intent with an aggressive surgical approach to R0 resection and total hepatectomy followed by orthotopic liver transplantation.
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Affiliation(s)
- H Petrowsky
- Pfleger Liver Institute, Dumont-UCLA Liver Cancer and Transplant Centers, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California 90095-7054, USA
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41
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Clinical impact of whole body FDG-PET for recurrent biliary cancer: a multicenter study. Ann Nucl Med 2009; 23:709-15. [DOI: 10.1007/s12149-009-0297-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 07/12/2009] [Indexed: 10/20/2022]
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Gakhal MS, Gheyi VK, Brock RE, Andrews GS. Multimodality Imaging of Biliary Malignancies. Surg Oncol Clin N Am 2009; 18:225-39, vii-viii. [DOI: 10.1016/j.soc.2008.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
BACKGROUND Surgery has become heavily dependent on accurate imaging in the assessment and treatment of suspected or confirmed intra-abdominal malignancy. Positron emission tomography-computed tomography (PET-CT) fuses uptake of a radiotracer combined with CT images to assess both functional tissue activity and anatomical detail. Since its introduction it has offered new ways of treating gastrointestinal cancers. METHODS The review analyses the present literature regarding the use of PET-CT in the assessment, diagnosis, staging and treatment of hepatobiliary malignancies. RESULTS PET-CT is widely used in pre-operative tumours staging for colorectal liver metastases. There is convincing data that it may also be applicable for neuroendocrine tumours, assessment of indeterminate pancreas lesions and clinical drug trials. PET-CT is of limited value in hepatocellular cancers, although new techniques in dual-tracer PET-CT may change this. CONCLUSION Knowledge of the strengths and limitations of PET-CT is important for all surgeons managing cancer of the hepatobiliary system. More clinical data are required on PET-CT, particularly its effect on long-term survival in PET-CT-staged patients undergoing resection.
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Affiliation(s)
- Ginseppe Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth HospitalAdelaide, SA, Australia
| | - Seok Ling Ong
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General HospitalLeicester, UK
| | - Guy J Maddern
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth HospitalAdelaide, SA, Australia
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Animal PET for thioacetamide-induced rat cholangiocarcinoma: a novel and reliable platform. Mol Imaging Biol 2008; 10:209-16. [PMID: 18491193 DOI: 10.1007/s11307-008-0141-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 01/19/2008] [Accepted: 02/12/2008] [Indexed: 12/22/2022]
Abstract
PURPOSE Cholangiocarcinoma (CCA) is a lethal disease afflicting many thousands of patients worldwide. We have previously developed an oral thioacetamide (TAA)-induced model of rat CCA that recapitulates the histologic progression of human CCA. Our objective was to evaluate the feasibility of animal PET in detecting CCA in the setting of the TAA rat model. PROCEDURES Male Sprague-Dawley rats (n = 30) were used in this study. Drinking water with TAA 300 mg/l was administered orally in 26 rats, and animal PET was performed at 20 weeks after initiation of TAA. A total of four rats served as controls. Animal PET images were acquired sequentially using both C-11 acetate and 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) to determine the optimal tracer. Dynamic animal PET images were collected to assess the optimal scan time based on the highest tumor-to-liver (T/L) ratio using time-activity curves. Animal PET findings were compared lesion by lesion with the results of autoradiography and the histological data. RESULTS FDG animal PET images had a higher T/L ratio compared to images obtained with C-11 acetate as a marker. The optimal scan time for FDG animal PET was determined as 90 min postinjection of the tracer. This was when the T/L ratio reached its peak. Necropsy and histology confirmed the presence of TAA-induced CCA in 22 rats (84.6 %). Static animal PET images showed intense FDG uptake in 17 of the 22 tumor-bearing animals (77.3%). The average T/L ratio was 1.60 +/- 0.09. The sensitivity and specificity of animal PET in the detection of CCA were 77% (17/22) and 100% (4/4), respectively. CONCLUSIONS We conclude that animal PET in the setting of the TAA rat model seems to be feasible for the detection of CCA. Future translational studies are needed to confirm and expand our findings.
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Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, Lee SS, Seo DW, Lee SK. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol 2008; 103:1145-51. [PMID: 18177454 DOI: 10.1111/j.1572-0241.2007.01710.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the clinical role of integrated positron emission and computed tomography (PET-CT) in patients with suspected and potentially operable cholangiocarcinoma. METHODS Between October 2005 and May 2007, 123 patients with suspected cholangiocarcinoma were enrolled in this study after diagnostic workup, including biliary dynamic computed tomography (CT) and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) with magnetic resonance (MR) angiography. Patients with overt unresectable cholangiocarcinoma or gallbladder cancer diagnosed via conventional imaging were excluded. Consecutively, each enrolled patient underwent PET-CT. Data were prospectively collected and analyzed in comparison with CT and MRI/MRCP. RESULTS The overall values for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT in primary tumor detection were 84.0%, 79.3%, 92.9%, 60.5%, and 82.9%, respectively. PET-CT demonstrated no statistically significant advantage over CT and MRI/MRCP in the diagnosis of primary tumor. According to different morphologic characteristics of cholangiocarcinoma, PET-CT showed no significant difference in detecting those of mass-forming, periductal-infiltrating, and intraductal-growing types. PET-CT revealed significantly higher accuracy over CT in the diagnosis of regional lymph nodes metastases (75.9%vs 60.9%, P= 0.004) and distant metastases (88.3%vs 78.7%, P= 0.004). Additional use of PET-CT for assessing resectability correctly showed different results from those determined by conventional imaging in 15 (15.9%) of 94 patients with cholangiocarcinoma. CONCLUSIONS PET-CT improved the accuracy of preoperative staging in patients with cholangiocarcinoma planning to undergo curative resection. Thus, PET-CT had an important clinical impact on the selection of proper treatment.
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Affiliation(s)
- Ji Y Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
F-18-FDG PET and PET/CT are useful for staging, predicting the prognosis, and evaluating recurrence and treatment response in hepatocellular carcinomas (HCCs) and cholangiocarcinomas. Increased F-18-FDG uptake within tumors could be a surrogate marker of aggressive behavior and poor clinical outcome, despite high false-negative rates in detecting primary intrahepatic low-grade HCCs and periductal-infiltrating cholangiocarcinomas. Dualtracer PET or PET/CT using carbon-11-acetate and F-18-FDG will increase diagnostic performance in HCC.
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Affiliation(s)
- Jong Doo Lee
- Division of Nuclear Medicine, Department of Diagnostic Radiology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, South Korea.
| | - Won Jun Kang
- Division of Nuclear Medicine, Department of Diagnostic Radiology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Mijin Yun
- Division of Nuclear Medicine, Department of Diagnostic Radiology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, South Korea
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Breitenstein S, Apestegui C, Clavien PA. Positron emission tomography (PET) for cholangiocarcinoma. HPB (Oxford) 2008; 10:120-1. [PMID: 18773069 PMCID: PMC2504390 DOI: 10.1080/13651820801992583] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Indexed: 12/12/2022]
Abstract
The combination of positron emission tomography (PET) with computed tomography (PET-CT) provides simultaneous metabolic and anatomic information on tumors in the same imaging session. Sensitivity of PET/PET-CT is higher for intrahepatic (>90%) than for extrahepatic cholangiocarcinoma (CCA) (about 60%). The detection rate of distant metastasis is 100%. PET, and particularly PET-CT, improves the results and impacts on the oncological management in CCA compared with other imaging modalities. Therefore, PET-CT is recommended in the preoperative staging of intrahepatic (strength of recommendation: moderate) and extrahepatic (strength of recommendation: low) CCA.
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Affiliation(s)
- S. Breitenstein
- From the Swiss HPB (Hepato-pancreato-Biliary) Center, Department of Surgery, University Hospital Zurich
| | - C. Apestegui
- From the Swiss HPB (Hepato-pancreato-Biliary) Center, Department of Surgery, University Hospital Zurich
| | - P.-A. Clavien
- From the Swiss HPB (Hepato-pancreato-Biliary) Center, Department of Surgery, University Hospital Zurich
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Uenishi T, Yamazaki O, Tanaka H, Takemura S, Yamamoto T, Tanaka S, Nishiguchi S, Kubo S. Serum cytokeratin 19 fragment (CYFRA21-1) as a prognostic factor in intrahepatic cholangiocarcinoma. Ann Surg Oncol 2007; 15:583-9. [PMID: 17955299 DOI: 10.1245/s10434-007-9650-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/13/2007] [Accepted: 09/17/2007] [Indexed: 12/30/2022]
Abstract
BACKGROUND A high serum cytokeratin 19 fragment (CYFRA21-1) concentration in patients with various cancers is associated with poor prognosis. This study aimed to establish the clinical significance of preoperative serum CYFRA21-1 in patients with intrahepatic cholangiocarcinoma. METHODS CYFRA21-1, carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9 concentrations were measured in sera from 71 patients with intrahepatic cholangiocarcinoma. The prognostic significance of serum CYFRA21-1 levels was assessed by univariate and multivariate analyses. RESULTS Analysis of the areas under the receiver operator characteristic (ROC) curves clearly showed better discrimination between intrahepatic cholangiocarcinoma and benign liver diseases for CYFRA 21-1 than for CEA or CA 19-9. Based on the maximization of the Youden's index, the optimal cut-off value was 2.7 ng ml(-1) for CYFRA 21-1 (sensitivity, 74.7%; specificity, 92.2%). The serum CYFRA21-1 concentration was related to tumor stage, since the CYFRA21-1 concentrations varied according to tumor size, vascular invasion, and number of tumors. The 3-year recurrence-free survival rates for patients with high and low concentrations of CYFRA21-1 were 25.0% and 76.2%, respectively (log-rank test, p < 0.01). The 3-year overall survival rates for patients with high and low concentrations of CYFRA21-1 were 39.4% and 63.6%, respectively (p = 0.01). On multivariate analysis, a high concentration of CYFRA21-1, nodal metastases, and a microscopic resection margin involvement were independent prognostic factors associated with both tumor recurrence and postoperative death. CONCLUSIONS A high serum CYFRA21-1 concentration is associated with tumor progression and poor postoperative outcomes in patients with intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Takahiro Uenishi
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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