Jordi Fuertes1, Clara Montagut2, Santi Bullich3, Mar Iglesias Coma4, Antoni Mestre-Fusco5, Marina Suárez-Piñera6, Carlos Trampal7, Joaquim Bellmunt8. 1. Nuclear Medicine Department, Hospital Universitari Sant Joan, Reus, Tarragona, Spain. Electronic address: jfm35709@yahoo.es. 2. Medical Oncology Department, University Hospital del Mar-IMIM, Universitat Pompeu Fabra, Parc de Salut Mar, Barcelona, Spain. Electronic address: cmontagut@parcdesalutmar.cat. 3. Molecular Imaging Centre, Barcelona Biomedical Research Park, Barcelona, Spain. Electronic address: sbullich@gmail.com. 4. Pathology Department, University Hospital del Mar-IMIM, Universitat Pompeu Fabra, Parc de Salut Mar, Barcelona, Spain. Electronic address: miglesias@parcdesalutmar.cat. 5. Nuclear Medicine Department, University Hospital del Mar, Parc de Salut Mar, Barcelona, Spain. Electronic address: tonimefu@hotmail.com. 6. Nuclear Medicine Department, University Hospital del Mar, Parc de Salut Mar, Barcelona, Spain. Electronic address: marina.suarez@crccorp.es. 7. Molecular Imaging Centre, Barcelona Biomedical Research Park, Barcelona, Spain. Electronic address: carlostrampal@gmail.com. 8. Medical Oncology Department, University Hospital del Mar-IMIM, Universitat Pompeu Fabra, Parc de Salut Mar, Barcelona, Spain. Electronic address: jbellmunt@parcdesalutmar.cat.
Abstract
PURPOSE: Unexpected focal colonic or rectal radiotracer activity is an usual finding in patients subjected to a PET study. The aim of this work has been to evaluate the clinical significance of this finding in the prediction of an existing colorectal malignancy. MATERIAL AND METHODS: During the last three years, all patients studied with (18)F-FDG PET/CT and PET for oncologic work-up purposes were prospectively surveyed for focal colorectal radiotracer activity. Colonoscopy was performed in all patients with this incidental finding in order to exclude colonic malignancy. CEA level, maximum standardized uptake value (SUVmax), CT findings, colonoscopy findings and histopathological results were prospectively analyzed in all patients. RESULTS: A total of 2290 patients were evaluated, 158 of whom were studied with PET and the remainder with a hybrid PET/CT. Focal FDG colorectal activity was incidentally detected in 27 patients with no previous history of colorectal cancer. Colorectal adenocarcinoma was diagnosed in seven (25.9%) patients. A pre-cancerous lesion was found in eleven patients (40.7%). Eight patients (29.6%) had no macroscopic lesions. One patient was diagnosed with a benign lesion. Any focal activity found in the colon by (18)F-FDG PET/CT examination predicts a probability greater than 50% of an underlying malignant or premalignant lesion in the histopathological analysis (logistic regression, p=0.01), independently of the calculated SUVmax. CONCLUSION: According to the results of the present study, we recommend the performance of a colonoscopy and biopsy of any suspicious lesions, in all patients with unexpected focal FDG activity found in colon or rectum during a (18)F-FDG PET/CT examination.
PURPOSE: Unexpected focal colonic or rectal radiotracer activity is an usual finding in patients subjected to a PET study. The aim of this work has been to evaluate the clinical significance of this finding in the prediction of an existing colorectal malignancy. MATERIAL AND METHODS: During the last three years, all patients studied with (18)F-FDG PET/CT and PET for oncologic work-up purposes were prospectively surveyed for focal colorectal radiotracer activity. Colonoscopy was performed in all patients with this incidental finding in order to exclude colonic malignancy. CEA level, maximum standardized uptake value (SUVmax), CT findings, colonoscopy findings and histopathological results were prospectively analyzed in all patients. RESULTS: A total of 2290 patients were evaluated, 158 of whom were studied with PET and the remainder with a hybrid PET/CT. Focal FDG colorectal activity was incidentally detected in 27 patients with no previous history of colorectal cancer. Colorectal adenocarcinoma was diagnosed in seven (25.9%) patients. A pre-cancerous lesion was found in eleven patients (40.7%). Eight patients (29.6%) had no macroscopic lesions. One patient was diagnosed with a benign lesion. Any focal activity found in the colon by (18)F-FDG PET/CT examination predicts a probability greater than 50% of an underlying malignant or premalignant lesion in the histopathological analysis (logistic regression, p=0.01), independently of the calculated SUVmax. CONCLUSION: According to the results of the present study, we recommend the performance of a colonoscopy and biopsy of any suspicious lesions, in all patients with unexpected focal FDG activity found in colon or rectum during a (18)F-FDG PET/CT examination.
Authors: Jong Il Lee; Sang Sik Cho; Ui Sup Shin; Byong Ho Jeon; Sun Mi Moon; Younjoo Kim; Ki Young Yang; Byung Il Kim Journal: Sci Rep Date: 2021-07-19 Impact factor: 4.379