J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 2093-0488 The Korean Surgical Society 10.4174/jkss.2010.79.1.43 Original Article The Usefulness of FDG-PET/CT for the Prediction of Regional Lymph Node Metastases in Colorectal Cancer Bang Mi Ji M.D. Jung Sang Hun M.D. Kim Jae Hwang M.D. Shim Min Chul M.D. Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea. Corresponding author (98jshgs@hanmail.net) 07 2010 25 06 2010 79 1 43 48 01 02 2010 26 03 2010 Copyright © 2010 The Korean Surgical Society 2010 Purpose

Proper preoperative staging is important in planning optimal therapy for individual patients and improving outcome. There is no ideal imaging methods for accurate colorectal cancer staging. The purpose of our study was to determine the usefulness of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) for the status of regional lymph node metastasis in colorectal cancer.

 Methods

Two hundred forty six surgically resected colorectal cancers were retrospectively reviewed from Jan 2007 to Jul 2009. All patients underwent abdominal CT and FDG-PET/CT preoperatively.

 Results

There were 129 males (52.4%) and the mean age was 62 (range: 25~88 years). Tumor location was the colon in 148 (59.7%) patients, and the rectum in 98 (40.3%) patients. Pathological stages were I: 43 (17.5%), II: 78 (31.7%), III: 81 (32.9%), IV: 44 (17.9%). Regional lymph node metastasis by pathological examination was 118 (48%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of regional lymph node staging were 66.4%, 66.7%, 64.8%, 68.3%, and 67%, respectively, with the FDG-PET/CT, and 57.1%, 71.3%, 64.8%, 64.3%, and 65%, respectively, with whole abdominal CT. The difference in the accuracy of nodal staging between the two modalities was not significant.

 Conclusion

The diagnostic accuracy of FDG-PET/CT for the assessment of regional lymph node metastasis in colorectal cancer was relatively low, and similar to that of abdominal CT. Therefore, further study will be needed to determine the clinical usefulness of preoperative FDG-PET/CT in colorectal cancer.

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(A) Computed tomography (CT) transaxial image. Preoperative CT shows irregular wall thickness and pericolic fat infiltration of ascending colon and pericolic lymph node (LN) enlargement. (B) 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) fused transaxial image. Preoperative FDG-PET/CT shows FDG uptake of ascending colon, pericolic and ileocolic LN.

Patients characteristics

Diagnostic accuracy in node staging

*PPV = positive predictive value; †NPV = negative predictive value.

Diagnostic accuracy in node staging according to patients characteristics

*Rt. colon (68), Lt. colon (80).