Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer.

Hdl Handle:
http://hdl.handle.net/10675.2/97
Title:
Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer.
Authors:
Sarikaya, Ismet; Povoski, Stephen P; Al-Saif, Osama H; Kocak, Ergun; Bloomston, Mark; Marsh, Steven; Cao, Zongjian; Murrey, Douglas A; Zhang, Jun; Hall, Nathan C; Knopp, Michael V; Martin, Edward W
Abstract:
BACKGROUND: The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (18F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients. METHODS: Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31-78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9). Preoperative FDG-PET scan and intraoperative GP study were performed in all patients. Mean time interval between preoperative FDG-PET scan and surgery was 16 days (range 1-41 days) in 19 patients. For intraoperative GP studies, 19 patients were injected with a dose of 10-15 mCi 18F FDG at approximately 30 minutes before the planned surgery time. In two patients, the intraoperative GP study was performed immediately after preoperative FDG-PET scan. RESULTS: Preoperative FDG-PET and intraoperative GP detected 48 and 45 lesions, respectively. A total of 50 presumed site of recurrent disease from 20 patients were resected. Thirty-seven of 50 presumed sites of recurrent disease were histological-proven tumor positive and 13 of 50 presumed sites of recurrent disease were histological-proven tumor negative. When correlated with final histopathology, the number of true positive lesions and false positive lesions by preoperative FDG-PET and intraoperative GP were 31/9 and 35/8, respectively. Both preoperative FDG-PET and intraoperative GP were true positive in 29 lesions. Intraoperative GP detected additional small lesions in the omentum and pelvis which were not seen on preoperative FDG-PET scan. FDG-PET scan demonstrated additional liver metastases which were not detected by intraoperative GP. Preoperative FDG-PET detected distant metastasis in the lung in one patient. The estimated radiation dose received by a surgeon during a single 18F FDG GP surgery was below the occupational limit. CONCLUSION: The combined use of preoperative FDG-PET and intraoperative GP is potentially helpful to the surgeon as a roadmap for accurately locating and determining the extent of tumor recurrence in patients with CRC. While intraoperative GP appears to be more sensitive in detecting the extent of abdominal and pelvic recurrence, preoperative FDG-PET appears to be more sensitive in detecting liver metastases. FDG-PET is also a valuable method in detecting distant metastases.
Citation:
World J Surg Oncol. 2007 Jul 16; 5:80
Issue Date:
9-Aug-2007
URI:
http://hdl.handle.net/10675.2/97
DOI:
10.1186/1477-7819-5-80
PubMed ID:
17634125
PubMed Central ID:
PMC1941735
Type:
Journal Article
ISSN:
1477-7819
Appears in Collections:
Department of Radiology: Faculty Research and Presentations

Full metadata record

DC FieldValue Language
dc.contributor.authorSarikaya, Ismeten_US
dc.contributor.authorPovoski, Stephen Pen_US
dc.contributor.authorAl-Saif, Osama Hen_US
dc.contributor.authorKocak, Ergunen_US
dc.contributor.authorBloomston, Marken_US
dc.contributor.authorMarsh, Stevenen_US
dc.contributor.authorCao, Zongjianen_US
dc.contributor.authorMurrey, Douglas Aen_US
dc.contributor.authorZhang, Junen_US
dc.contributor.authorHall, Nathan Cen_US
dc.contributor.authorKnopp, Michael Ven_US
dc.contributor.authorMartin, Edward Wen_US
dc.date.accessioned2010-09-24T22:03:18Z-
dc.date.available2010-09-24T22:03:18Z-
dc.date.issued2007-08-09en_US
dc.identifier.citationWorld J Surg Oncol. 2007 Jul 16; 5:80en_US
dc.identifier.issn1477-7819en_US
dc.identifier.pmid17634125en_US
dc.identifier.doi10.1186/1477-7819-5-80en_US
dc.identifier.urihttp://hdl.handle.net/10675.2/97-
dc.description.abstractBACKGROUND: The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (18F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients. METHODS: Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31-78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9). Preoperative FDG-PET scan and intraoperative GP study were performed in all patients. Mean time interval between preoperative FDG-PET scan and surgery was 16 days (range 1-41 days) in 19 patients. For intraoperative GP studies, 19 patients were injected with a dose of 10-15 mCi 18F FDG at approximately 30 minutes before the planned surgery time. In two patients, the intraoperative GP study was performed immediately after preoperative FDG-PET scan. RESULTS: Preoperative FDG-PET and intraoperative GP detected 48 and 45 lesions, respectively. A total of 50 presumed site of recurrent disease from 20 patients were resected. Thirty-seven of 50 presumed sites of recurrent disease were histological-proven tumor positive and 13 of 50 presumed sites of recurrent disease were histological-proven tumor negative. When correlated with final histopathology, the number of true positive lesions and false positive lesions by preoperative FDG-PET and intraoperative GP were 31/9 and 35/8, respectively. Both preoperative FDG-PET and intraoperative GP were true positive in 29 lesions. Intraoperative GP detected additional small lesions in the omentum and pelvis which were not seen on preoperative FDG-PET scan. FDG-PET scan demonstrated additional liver metastases which were not detected by intraoperative GP. Preoperative FDG-PET detected distant metastasis in the lung in one patient. The estimated radiation dose received by a surgeon during a single 18F FDG GP surgery was below the occupational limit. CONCLUSION: The combined use of preoperative FDG-PET and intraoperative GP is potentially helpful to the surgeon as a roadmap for accurately locating and determining the extent of tumor recurrence in patients with CRC. While intraoperative GP appears to be more sensitive in detecting the extent of abdominal and pelvic recurrence, preoperative FDG-PET appears to be more sensitive in detecting liver metastases. FDG-PET is also a valuable method in detecting distant metastases.en_US
dc.rightsThe PMC Open Access Subset is a relatively small part of the total collection of articles in PMC. Articles in the PMC Open Access Subset are still protected by copyright, but are made available under a Creative Commons or similar license that generally allows more liberal redistribution and reuse than a traditional copyrighted work. Please refer to the license statement in each article for specific terms of use. The license terms are not identical for all articles in this subset.en_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshCarcinoembryonic Antigen / blooden_US
dc.subject.meshColorectal Neoplasms / pathologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshFluorodeoxyglucose F18 / diagnostic useen_US
dc.subject.meshGamma Camerasen_US
dc.subject.meshHumansen_US
dc.subject.meshIntraoperative Perioden_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNeoplasm Metastasis / radionuclide imagingen_US
dc.subject.meshPositron-Emission Tomographyen_US
dc.subject.meshRadiation Dosageen_US
dc.subject.meshRadiopharmaceuticals / diagnostic useen_US
dc.titleCombined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer.en_US
dc.typeJournal Articleen_US
dc.identifier.pmcidPMC1941735en_US
dc.contributor.corporatenameDepartment of Radiologyen_US
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