A case-controlled study of 18-fluorodeoxyglucose positron emission tomography in the detection of pelvic recurrence in previously irradiated rectal cancer patients

Harvey G. Moore, Tim Akhurst, Steven M. Larson, Bruce D. Minsky, Madhu Mazumdar, Jose G. Guillem

Research output: Contribution to journalArticlepeer-review

78 Scopus citations

Abstract

BACKGROUND: Although effective at detecting locally recurrent colorectal cancer, the accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting rectal cancer recurrence in an irradiated pelvis has not been systematically studied. STUDY DESIGN: Records of surgically resected rectal cancer patients who underwent FDG-PET imaging at least 6 months after external beam radiation therapy (EBRT) were reviewed. Cases (n = 19) were defined as scans from patients in whom a pelvic recurrence was confirmed (histologically, n = 14, radiologic followup, n = 5). Controls (n = 41), defined as scans from patients without clinical or radiologic evidence of pelvic recurrence, were compared with cases for the time interval between completion of EBRT and FDG-PET imaging (RT/PET interval, mean 25.1 months versus 27.5 months, respectively), as well as EBRT dose (mean 5,084 cGy versus 5,062 cGy, respectively). All 60 FDG-PET scans were iteratively reconstructed and reinterpreted by a single nuclear medicine physician blinded to original FDG-PET interpretation and disease status. Certainty of disease was scored on a five-point scale (1 to 5), with scores greater than or equal to 4 considered positive. RESULTS: FDG-PET correctly identified 16 of 19 recurrences, for a sensitivity of 84% and specificity of 88%. Overall accuracy was 87%. Positive predictive value was 76% and negative predictive value was 92%. Positive predictive value and accuracy improved in scans performed more than 12 months after EBRT. CONCLUSIONS: Our preliminary data suggest that FDG-PET is an accurate modality for detecting pelvic recurrence of rectal cancer after full-dose EBRT. Its reliability appears to improve with time, perhaps because of resolution of early postradiation inflammation.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalJournal of the American College of Surgeons
Volume197
Issue number1
DOIs
StatePublished - 1 Jul 2003
Externally publishedYes

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