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Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data

Peter Smeets UGent, Hamphrey Ham UGent, Wim Ceelen UGent, Tom Boterberg UGent, Koenraad Verstraete UGent and Ingeborg Goethals UGent (2010) QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. 54(3). p.327-332
abstract
Aim. The aim of this study was to evaluate the usefulness of visual and semiquantitative [F-18]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) data for the diagnosis of peri-anastomotic colorectal cancer recurrence, taking into account the time period between surgery and [F-18]FDG PET-CT scanning. Methods. The study population consisted of 70 patients who had prior preoperative radiochemotherapy and surgical resection of the primary tumor and who underwent whole body [F-18]FDG PET-CT scanning for the detection of recurrent disease. Visual and semiquantitative (SUVmax) analysis of [F-18]FDG uptake at the peri-anastomosis was performed. The final diagnosis was based on pathological proof or clinical and/or imaging follow-up data. Results. On visual reading, 27 patients exhibited increased [F-18]FDG uptake at the peri-anastomosis. Of these, 11 (41%) patients had a local tumor recurrence and 16 (59%) had no recurrent tumor. Among the 43 patients without increased [F-18]FDG uptake at the peri-anastomosis, none had local tumor recurrence. On semiquantitation, SUVmax in patients with and without a local recurrence overlapped. However, when the time period between surgery and [F-18]FDG PET-CT scanning was taken into account, overlap of SUVmax was mainly observed within a postoperative period of <= 12 months; thereafter, a threshold SUVmax of 3.2 discriminated between benign and malignant lesions in all but one patient. Conclusion. In our series, visually increased [F-18]FDG uptake at the peri-anastomosis was 100% sensitive but non-specific (73% specificity) for the diagnosis of local tumor recurrence. On the other hand, normal [F-18]FDG uptake at the peri-anastomosis precluded a local tumor recurrence (a negative predictive value of 100%). In addition, semiquantitative (SUVmax) analysis of [F-18]FDG uptake at the peri-anastomosis may increase specificity (up to 97%), while preserving maximum sensitivity, if the postoperative period is >12 months.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
POSITRON-EMISSION-TOMOGRAPHY, PRACTICE GUIDELINE, ROI DEFINITION, Positron-emission tomography, Computed tomography, surgical, Fluorodeoxyglucose F18, Anastomosis, Colorectal neoplasms, CARCINOMA, RESOLUTION, PATTERNS, RECONSTRUCTION, TRIALS, UPTAKE VALUES, CURATIVE RESECTION
journal title
QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Q. J. Nucl. Med. Mol. Imag.
volume
54
issue
3
pages
327 - 332
Web of Science type
Article
Web of Science id
000284496300008
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
2.537 (2010)
JCR rank
41/111 (2010)
JCR quartile
2 (2010)
ISSN
1824-4661
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1261245
handle
http://hdl.handle.net/1854/LU-1261245
date created
2011-06-14 11:24:51
date last changed
2011-06-20 16:02:52
@article{1261245,
  abstract     = {Aim. The aim of this study was to evaluate the usefulness of visual and semiquantitative [F-18]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) data for the diagnosis of peri-anastomotic colorectal cancer recurrence, taking into account the time period between surgery and [F-18]FDG PET-CT scanning.
Methods. The study population consisted of 70 patients who had prior preoperative radiochemotherapy and surgical resection of the primary tumor and who underwent whole body [F-18]FDG PET-CT scanning for the detection of recurrent disease. Visual and semiquantitative (SUVmax) analysis of [F-18]FDG uptake at the peri-anastomosis was performed. The final diagnosis was based on pathological proof or clinical and/or imaging follow-up data.
Results. On visual reading, 27 patients exhibited increased [F-18]FDG uptake at the peri-anastomosis. Of these, 11 (41\%) patients had a local tumor recurrence and 16 (59\%) had no recurrent tumor. Among the 43 patients without increased [F-18]FDG uptake at the peri-anastomosis, none had local tumor recurrence. On semiquantitation, SUVmax in patients with and without a local recurrence overlapped. However, when the time period between surgery and [F-18]FDG PET-CT scanning was taken into account, overlap of SUVmax was mainly observed within a postoperative period of {\textlangle}= 12 months; thereafter, a threshold SUVmax of 3.2 discriminated between benign and malignant lesions in all but one patient.
Conclusion. In our series, visually increased [F-18]FDG uptake at the peri-anastomosis was 100\% sensitive but non-specific (73\% specificity) for the diagnosis of local tumor recurrence. On the other hand, normal [F-18]FDG uptake at the peri-anastomosis precluded a local tumor recurrence (a negative predictive value of 100\%). In addition, semiquantitative (SUVmax) analysis of [F-18]FDG uptake at the peri-anastomosis may increase specificity (up to 97\%), while preserving maximum sensitivity, if the postoperative period is {\textrangle}12 months.},
  author       = {Smeets, Peter and Ham, Hamphrey and Ceelen, Wim and Boterberg, Tom and Verstraete, Koenraad and Goethals, Ingeborg},
  issn         = {1824-4661},
  journal      = {QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING},
  keyword      = {POSITRON-EMISSION-TOMOGRAPHY,PRACTICE GUIDELINE,ROI DEFINITION,Positron-emission tomography,Computed tomography,surgical,Fluorodeoxyglucose F18,Anastomosis,Colorectal neoplasms,CARCINOMA,RESOLUTION,PATTERNS,RECONSTRUCTION,TRIALS,UPTAKE VALUES,CURATIVE RESECTION},
  language     = {eng},
  number       = {3},
  pages        = {327--332},
  title        = {Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data},
  volume       = {54},
  year         = {2010},
}

Chicago
Smeets, Peter, Hamphrey Ham, Wim Ceelen, Tom Boterberg, Koenraad Verstraete, and Ingeborg Goethals. 2010. “Differentiation Between Peri-anastomotic Inflammatory Changes and Local Recurrence Following Neoadjuvant Radiochemotherapy Surgery for Colorectal Cancer Using Visual and Semiquantitative Analysis of PET-CT Data.” Quarterly Journal of Nuclear Medicine and Molecular Imaging 54 (3): 327–332.
APA
Smeets, P., Ham, H., Ceelen, W., Boterberg, T., Verstraete, K., & Goethals, I. (2010). Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data. QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, 54(3), 327–332.
Vancouver
1.
Smeets P, Ham H, Ceelen W, Boterberg T, Verstraete K, Goethals I. Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data. QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. 2010;54(3):327–32.
MLA
Smeets, Peter, Hamphrey Ham, Wim Ceelen, et al. “Differentiation Between Peri-anastomotic Inflammatory Changes and Local Recurrence Following Neoadjuvant Radiochemotherapy Surgery for Colorectal Cancer Using Visual and Semiquantitative Analysis of PET-CT Data.” QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 54.3 (2010): 327–332. Print.