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Clinical value of 18F-FDG- PET-CT in the preoperative staging of peritoneal carcinomatosis from colorectal origin

Nicolas De Vos (UGent) , Ingeborg Goethals (UGent) and Wim Ceelen (UGent)
(2014) ACTA CHIRURGICA BELGICA. 114(6). p.370-375
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Abstract
Background : Adequate staging is essential in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who are candidates for cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Metabolic imaging using F-18-FDG-PET-CT is commonly used to exclude distant metastasis in these patients. Here, we aimed to assess the performance of F-18-FDG-PET-CT in locoregional staging of the extent of PC. Methods : Patients with PC from CRC underwent staging including F-18-FDG-PET-CT. In the absence of systemic dissemination, CRS and oxaliplatin based HIPEC were performed. The extent of PC was quantified during surgery using the modified 7 region count (7RC). The correlation between imaging based estimation of PC extent and surgical 7RC was analyzed using Pearson correlation using both patient based and region based analyses. Results : Fifty-five patients were included between February 2005 and October 2018. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 57%, 98%, 95%, 78% and 82% respectively for nonmucinous tumors and 32%, 100%, 100%, 55% and 63% respectively. 18F-FDG-PET-CT detected the presence of colorectal PC in 96% of patients suffering from PC with nonmucinous histology and in 60% of patients suffering from PC with mucinous histology. Correlation between imaging 7RC and surgical 7RC was better for PC with nonmucinous histology (r = 0.623) than for PC with mucinous histology (r = -0.180). Conclusions : Despite of underestimating the exact extent of disease involvement, 18F-FDG-PET-CT shows good performance in detecting colorectal PC with nonmucinous histology. For colorectal PC with mucinous histology, 18F-FDG-PET-CT, however, shows poor performance. Since 18F-FDG-PET-CT did not detect the presence of colorectal PC in all patients in whom long-term survival could be achieved, 18F-FDG-PET-CT should be implemented into a broad pre-operative assessment strategy.
Keywords
CYTOREDUCTIVE SURGERY, HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY, FDG-PET/CT, CANCER

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MLA
De Vos, Nicolas, Ingeborg Goethals, and Wim Ceelen. “Clinical Value of 18F-FDG- PET-CT in the Preoperative Staging of Peritoneal Carcinomatosis from Colorectal Origin.” ACTA CHIRURGICA BELGICA 114.6 (2014): 370–375. Print.
APA
De Vos, N., Goethals, I., & Ceelen, W. (2014). Clinical value of 18F-FDG- PET-CT in the preoperative staging of peritoneal carcinomatosis from colorectal origin. ACTA CHIRURGICA BELGICA, 114(6), 370–375.
Chicago author-date
De Vos, Nicolas, Ingeborg Goethals, and Wim Ceelen. 2014. “Clinical Value of 18F-FDG- PET-CT in the Preoperative Staging of Peritoneal Carcinomatosis from Colorectal Origin.” Acta Chirurgica Belgica 114 (6): 370–375.
Chicago author-date (all authors)
De Vos, Nicolas, Ingeborg Goethals, and Wim Ceelen. 2014. “Clinical Value of 18F-FDG- PET-CT in the Preoperative Staging of Peritoneal Carcinomatosis from Colorectal Origin.” Acta Chirurgica Belgica 114 (6): 370–375.
Vancouver
1.
De Vos N, Goethals I, Ceelen W. Clinical value of 18F-FDG- PET-CT in the preoperative staging of peritoneal carcinomatosis from colorectal origin. ACTA CHIRURGICA BELGICA. 2014;114(6):370–5.
IEEE
[1]
N. De Vos, I. Goethals, and W. Ceelen, “Clinical value of 18F-FDG- PET-CT in the preoperative staging of peritoneal carcinomatosis from colorectal origin,” ACTA CHIRURGICA BELGICA, vol. 114, no. 6, pp. 370–375, 2014.
@article{5958292,
  abstract     = {Background : Adequate staging is essential in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who are candidates for cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Metabolic imaging using F-18-FDG-PET-CT is commonly used to exclude distant metastasis in these patients. Here, we aimed to assess the performance of F-18-FDG-PET-CT in locoregional staging of the extent of PC.
Methods : Patients with PC from CRC underwent staging including F-18-FDG-PET-CT. In the absence of systemic dissemination, CRS and oxaliplatin based HIPEC were performed. The extent of PC was quantified during surgery using the modified 7 region count (7RC). The correlation between imaging based estimation of PC extent and surgical 7RC was analyzed using Pearson correlation using both patient based and region based analyses.
Results : Fifty-five patients were included between February 2005 and October 2018. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 57%, 98%, 95%, 78% and 82% respectively for nonmucinous tumors and 32%, 100%, 100%, 55% and 63% respectively. 18F-FDG-PET-CT detected the presence of colorectal PC in 96% of patients suffering from PC with nonmucinous histology and in 60% of patients suffering from PC with mucinous histology. Correlation between imaging 7RC and surgical 7RC was better for PC with nonmucinous histology (r = 0.623) than for PC with mucinous histology (r = -0.180).
Conclusions : Despite of underestimating the exact extent of disease involvement, 18F-FDG-PET-CT shows good performance in detecting colorectal PC with nonmucinous histology. For colorectal PC with mucinous histology, 18F-FDG-PET-CT, however, shows poor performance. Since 18F-FDG-PET-CT did not detect the presence of colorectal PC in all patients in whom long-term survival could be achieved, 18F-FDG-PET-CT should be implemented into a broad pre-operative assessment strategy.},
  author       = {De Vos, Nicolas and Goethals, Ingeborg and Ceelen, Wim},
  issn         = {0001-5458},
  journal      = {ACTA CHIRURGICA BELGICA},
  keywords     = {CYTOREDUCTIVE SURGERY,HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY,FDG-PET/CT,CANCER},
  language     = {eng},
  number       = {6},
  pages        = {370--375},
  title        = {Clinical value of 18F-FDG- PET-CT in the preoperative staging of peritoneal carcinomatosis from colorectal origin},
  volume       = {114},
  year         = {2014},
}

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