Is It Useful to Perform Additional Colonoscopy to Detect Unmatched Lesion between Positron Emission Tomography/Computed Tomography and Colonoscopy?

Chang Yong Yun; Jun-Oh Jung; Seong O Suh; Ji Won Yoo; Yu Mi Oh; Soo Min Ahn; Hyoung Hun Sim; Eun Sil Kim; Ji Yoon Bae

doi:10.4166/kjg.2013.61.6.319

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Yun, Jung, Suh, Yoo, Oh, Ahn, Sim, Kim, and Bae: Is It Useful to Perform Additional Colonoscopy to Detect Unmatched Lesion between Positron Emission Tomography/Computed Tomography and Colonoscopy?

Original Article

Korean J Gastroenterol 2013;61(6):319-326.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.6.319

Is It Useful to Perform Additional Colonoscopy to Detect Unmatched Lesion between Positron Emission Tomography/Computed Tomography and Colonoscopy?

Chang Yong Yun, Jun-Oh Jung, Seong O Suh, Ji Won Yoo, Yu Mi Oh, Soo Min Ahn, Hyoung Hun Sim, Eun Sil Kim¹, Ji Yoon Bae²

Department of Internal Medicine, National Police Hospital, Seoul, Korea

¹Department of Nuclear Medicine, National Police Hospital, Seoul, Korea

²Department of Pathology, National Police Hospital, Seoul, Korea

Correspondence to: Jun-Oh Jung, Department of Internal Medicine, National Police Hospital, 123 Songyi-ro, Songpa-gu, Seoul 138-708, Korea. Tel: +82-2-3400-1208, Fax: +82-2-3400-1164, E-mail: jungjuno@nate.com

Received 29 March 20139 May 2013 Accepted 10 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Incidentally detected focal ¹⁸ F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy.

Methods

We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy.

Results

PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia).

Conclusions

Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.

Keywords: Positron-emission tomography and computed tomography, Colonic neoplasms, Colonoscopy

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Fig. 1.

Flow diagram of patient dis-position and outcome.

Fig. 2.

PET (A) and PET/CT (B) images showed an focal increased ¹⁸ F-fluoro-deoxyglucose uptake (A, black arrow; B, white arrow) at the sigmoid colon in a 51-year-old asymptomatic man. (C) A 20-mm sized adenocarcinoma of the sigmoid colon was observed and removed with colonoscopy.

Table 1.

Comparison of PET/CT and Colonoscopic Results

	FDG uptake in PET/CT		Total
	Focal uptake	No uptake	Total
Colonoscopy
Positive Negative^a	4158	34	75 58
Total	99	34	133

Values are presented as number of lesions.

FDG, ¹⁸ F-fluorodeoxyglucose.

^a Negative results include hyperplastic polyps, nonspecific colitis, normal mucosa.

Table 2.

Comparison of PET/CT Visibility of Adenoma according to the Histology

	FDG uptake in PET/CT		p-value
	Focal uptake	No uptake	p-value
Degree of dysplasia
Low grade dysplasia	28 (47.4)	31 (52.6)	0.027
High grade dysplasia	11 (78.5)	3 (21.5)
Adenocarcinoma	2 (100.0)	0 (0.0)
Histologic type
Tubular	30 (46.8)	33 (53.2)	0.040
Tubulovillous	5 (87.5)	1 (12.5)
Villous	4 (100.0)	0 (0.0)

Values are presented as number of lesions (%).

FDG, ¹⁸ F-fluorodeoxyglucose.

Table 3.

Comparison of PET/CT Visibility of Adenoma according to the Location

	FDG uptake in PET/CT		p-value
	Focal uptake	No uptake	p-value
Ascending colon	7 (43.7)	9 (56.3)	0.388
Transverse colon	3 (60.0)	2 (40.0)
Descending colon	10 (71.4)	4 (28.6)
Sigmoid colon	14 (46.6)	16 (53.4)
Rectum	7 (70.0)	3 (30.0)

Values are presented as number of lesions (%).

FDG, ¹⁸ F-fluorodeoxyglucose.

Table 4.

Comparison of PET/CT Visibility of Adenoma according to the Size

	FDG uptake in PET/CT		p-value
	Focal uptake	No uptake	p-value
Adenoma (mm)
≥10	7 (87.5)	1 (12.5)	0.038
＜10	32 (49.0)	33 (51.0)

Values are presented as number of lesions (%).

FDG, ¹⁸ F-fluorodeoxyglucose.

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