Ability of integrated positron emission and computed tomography to detect significant colonic pathology

The experience of a tertiary cancer center

Authors

  • Brian R. Weston MD,

    1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Revathy B. Iyer MD,

    1. Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Wei Qiao MS,

    1. Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Jeffrey H. Lee MD,

    1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Robert S. Bresalier MD,

    1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • William A. Ross MD

    Corresponding author
    1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-1402
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    • Fax: (713) 563-4398;


  • Specific author contributions are as follows. Conception: William A. Ross and Robert S. Bresalier; design: William A. Ross and Brian R. Weston; acquisition of data and data analysis: Brian R. Weston, William A. Ross, Revathy B. Iyer, and Wei Qiao; interpretation of results: Brian R. Weston, William A. Ross, and Jeffrey H. Lee; drafting of manuscript: William A. Ross and Brian R. Weston; critical revision of manuscript: Brian R. Weston, Revathy B. Iyer, Jeffrey H. Lee, Robert S Bresalier, and William A. Ross.

  • An oral presentation of the preliminary results of this study was presented during the 2008 Digestive Disease Week in San Diego, California, with the abstract appearing in Gastrointestinal Endoscopy, 2008; 67:AB82-AB83.

Abstract

BACKGROUND:

The ability of integrated positron emission tomography and computed axial tomography (PET-CT) to detect colonic pathology is not fully defined. The purpose of this study was to assess the ability of PET-CT to detect colonic pathology and to determine the significance of (18F)2-fluoro-2-deoxyglucose (18F-FDG) activity noted incidentally in the colon on PET-CT.

METHODS:

Records for all patients who underwent PET-CT and colonoscopy at our institution were reviewed. Patients with history of colonic malignancy or colon surgery were excluded.

RESULTS:

Fifty-eight patients had incidental colonic 18F-FDG activity on PET (Group A) and 272 had none (Group B). In Group A, 65% of patients had pathologic findings detected on colonoscopy that corresponded to the site of PET activity. Standardized uptake value (SUV) readings were not helpful in distinguishing true-positives from false-positives. In Group B, 11.8% of patients were found to have significant colonic findings. Lesions not detected by PET-CT included 4 colon cancers, 7 advanced adenomas, and 10 patients with colonic lymphoma. Overall, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT for detecting significant pathology were 53%, 93%, 65%, 89%, and 85%, respectively. For detecting colon cancer and adenomas 10 mm or more, the sensitivity, specificity, PPV, NPV, and accuracy of PET-CT were 72%, 90%, 45%, 96%, and 88%, respectively.

CONCLUSIONS:

Incidental colonic activity detected by PET-CT warrants further evaluation with colonoscopy. However, negative PET-CT does not rule out significant colonic pathology including colon cancer, advanced adenomas, or lymphoma. Cancer 2010. © 2010 American Cancer Society.

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