Scientific Papers
Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases☆

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Abstract

Background: Hepatectomy represents a standard and potentially curative therapy for hepatic colorectal metastases. However, up to two thirds of patients explored for resection are found to have unsuspected disease, which precludes resection.

Methods: In order to determine if 18F-FDG positron emission tomography (PET) scanning may prevent unnecessary surgery, a group of 40 patients being considered for hepatic resection but at high risk for unresectable disease by clinical criteria were subjected to whole body 18F-FDG-PET scanning. Effect on clinical outcome was evaluated. In addition, PET findings in the 25 patients who underwent resection of hepatic metastases were directly compared with the resected specimen to determine the sensitivity of 18F-FDG PET scanning in the liver.

Results: Findings on 18F-FDG-PET scanning influenced the clinical management in 16 patients (40%) and directly altered management in 9 cases (23%). Six patients were spared laparotomy, and 3 others had PET-directed surgery that found extrahepatic tumor and spared the patient unwarranted liver resection. In 3 cases PET missed peritoneal metastases found on laparotomy. In these cases all missed tumors were less than 1 cm in size. Out of 52 resected hepatic lesions, 18F-FDG-PET detected 37. Within the liver, sensitivity of detection was also related to size. Only 25% of hepatic lesions smaller than 1 cm were detected by PET, while 85% of lesions larger than 1 cm were detected.

Conclusions: FDG-PET is best for detecting extrahepatic disease. There are few false positives, and surgeons should carefully evaluate and biopsy extrahepatic positive sites. This test should be used for patients at high risk for extrahepatic disease and should be evaluated prospectively for all patients under consideration for liver resection.

Section snippets

Methods

Between June 1996 and June 1998 40 patients (median age 60 years, range 41 to 70; 21 men and 17 women) who were being evaluated for possible resection of colorectal liver metastases underwent a 18F-FDG-PET-scan as part of their preoperative staging at Memorial Sloan-Kettering Cancer Center (Table I). These patients were chosen for PET scanning based on four clinical scenarios that placed them at particularly high risk for extrahepatic disease and for high risk of tumor recurrences after liver

Demographics

The patients in this study were of a typical age and gender distribution for patients with metastatic colorectal cancers to the liver (Table I). The median age was 60, and the gender distribution was 21 men and 19 women. This was overall a high-risk group for extrahepatic disease: the median clinical risk score (CRS) was 3. The indications for PET scans were four clinical scenarios. The first group consisted of 11 patients with a site of suspected extrahepatic disease. Of these, there were 4

Comments

It has been recognized for over a decade that positron emission tomography can be used to detect liver metastases from colorectal cancers after 18F-FDG administration.16, 17 Three previous studies have sought to specifically determine the utility of this modality in the preoperative assessment of patients with liver metastases.18, 19, 20 Beets et al18 examined 15 patients with resectable liver metastases, and the PET scan found additional unsuspected disease in the liver in 4 patients. The

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    ☆

    This work was supported in part by grants RO1CA76416, RO1CA72632, and RO1CA61524 from the National Institutes of Health and by the Laurent and Alberta Gerschel Foundation.

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