Liver Cancer pp 387-406 | Cite as

Colorectal Liver Metastases: 18F-Fluorodeoxyglucose-Positron Emission Tomography

  • Stéphanie Truant
  • Damien Huglo
  • François-René Pruvot
Part of the Methods of Cancer Diagnosis, Therapy and Prognosis book series (HAYAT, volume 5)

During the last years, 18F-fluorodeoxyglucosepositron emission tomography (FDG-PET) has been advocated as a useful tool in the management of recurrent colorectal cancer, mainly in liver and pelvic recurrences, whereas regarding the primary tumor, FDG-PET has proven to show very poor yield in comparison with conventional diagnostic methods. In the first meta-analysis of the literature for whole-body FDG-PET detection of recurrent colorectal cancer, FDG-PET had a positive impact on surgical decision-making in 29% of patients (Huebner et al., 2000). On the other hand, in the beginning of FDG-PET, most studies on colorectal liver metastases have shown limitations. Survey of previous reports shows indeed heterogeneous study designs that were mostly retrospective and simultaneously included various subsets of circumstances, e.g., preopera-tive staging of liver metastases together with locoregional recurrence, unexplained elevated serum carcinoembryonic antigen (CEA) levels and/or symptoms with negative imaging. The methodology to define the true lesion status of the FDG-PET findings was also variable from one study to another, including histopathologic analy-sis (performed at surgery, biopsy, and autopsy), intraoperative observation (e.g., manual palpation or ultrasonogra-phy) and/or 6-months or 1-year follow-up. The rate of histological confirmation that is the gold standard particularly in the evaluation of false-positive and false-negative readings varied from < 10% to 95% (Truant et al., 2005). A non-standard method of image analysis, as well as some degree of inequivalence in FDG-PET and computed tomography (CT) performance, may have led to a misjudgement of their relative diagnostic performance, as reflected by high rates of FDG-PET/CT discordances (range, 10–31%). FDG-PET was performed prospectively and the interpretation of the FDG-PET images was generally made with a priori knowledge of results of conventional diagnostic procedures. In contrast, CT was reviewed retrospectively and performed at various institutions, resulting in its sensitivity and specificity rates being among the worst, which were reported in general literature regarding colorectal liver metastases. In the two meta-analyses performed in the beginning of the use of FDG-PET, only few studies fulfilled the inclusion criteria and the guidelines established by the authors, reflecting the limitations of published reports (Huebner et al., 2000; Kinkel et al., 2002). Over time, however, studies on FDG-PET have focused on more definite settings and have included more systematically histological verifications of FDG-PET findings, resulting in a better assessment of FDG-PET accuracy and impact. In this chapter, the yield of FDG-PET in colorectal liver metastases will be preferentially analyzed through these latter studies.


Liver Metastasis Standardize Uptake Value Hepatic Resection Hepatic Metastasis Colorectal Liver Metastasis 
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Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Stéphanie Truant
    • 1
  • Damien Huglo
    • 1
  • François-René Pruvot
    • 1
  1. 1.Service de Chirurgie Digestive et TransplantationHôpital HuriezLille CedexFrance

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