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Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery.
Ann Surg Oncol. 2007 Feb; 14(2):818-26.AS

Abstract

BACKGROUND

For patients with colorectal liver metastases, resection is the treatment of choice. Careful selection of these patients is crucial in order to reduce the chance of unexpected findings at laparotomy and abandoning further surgical intervention. Here, we evaluate the predictive value of CT and FDG-PET of the liver and extrahepatic findings compared to findings during laparotomy and 6 months follow-up.

METHODS

131 consecutive patients, selected for hepatic surgery for colorectal liver metastases by CT and FDG-PET, were evaluated prospectively. During surgery, the liver was assessed by intra-operative ultrasound, palpation and histology.

RESULTS

In 127 patients (97%), CT was true-positive for liver metastases. In 3 patients, CT was false-positive and in 1 patient false-negative. In 126 patients (96%), FDG-PET was true-positive for liver metastases, in 2 patients FDG-PET was false-negative, in 3 patients true-negative (negative FDG-PET, false-positive CT). At laparotomy a total of 363 liver metastases was identified: 63 lesions <10 mm [10 (16%) detected by both CT and FDG-PET], 172 lesions of 10-20 mm [123 (72%) CT-positive, 129 (75%) by FDG-PET-positive], and 28 lesions >20 mm [124 (97%) CT-positive, 121 (95%) FDG-PET-positive]. CT and FDG-PET missed approximately 30% of the smaller liver lesions, resulting in a significant change in clinical management during surgery in only nine patients.

CONCLUSIONS

CT and FDG-PET have a similar diagnostic yield for the identification of liver metastases; both modalities being adequate on a patient-basis but inadequate to detect the smallest of liver lesions. However, the clinical relevance of the latter is limited.

Authors+Show Affiliations

Department of Surgical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.wiering@chir.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17136470

Citation

Wiering, B, et al. "Comparison of Multiphase CT, FDG-PET and Intra-operative Ultrasound in Patients With Colorectal Liver Metastases Selected for Surgery." Annals of Surgical Oncology, vol. 14, no. 2, 2007, pp. 818-26.
Wiering B, Ruers TJ, Krabbe PF, et al. Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol. 2007;14(2):818-26.
Wiering, B., Ruers, T. J., Krabbe, P. F., Dekker, H. M., & Oyen, W. J. (2007). Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Annals of Surgical Oncology, 14(2), 818-26.
Wiering B, et al. Comparison of Multiphase CT, FDG-PET and Intra-operative Ultrasound in Patients With Colorectal Liver Metastases Selected for Surgery. Ann Surg Oncol. 2007;14(2):818-26. PubMed PMID: 17136470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. AU - Wiering,B, AU - Ruers,T J M, AU - Krabbe,P F M, AU - Dekker,H M, AU - Oyen,W J G, Y1 - 2006/11/29/ PY - 2006/08/11/received PY - 2006/10/04/accepted PY - 2006/10/02/revised PY - 2006/12/1/pubmed PY - 2007/4/14/medline PY - 2006/12/1/entrez SP - 818 EP - 26 JF - Annals of surgical oncology JO - Ann Surg Oncol VL - 14 IS - 2 N2 - BACKGROUND: For patients with colorectal liver metastases, resection is the treatment of choice. Careful selection of these patients is crucial in order to reduce the chance of unexpected findings at laparotomy and abandoning further surgical intervention. Here, we evaluate the predictive value of CT and FDG-PET of the liver and extrahepatic findings compared to findings during laparotomy and 6 months follow-up. METHODS: 131 consecutive patients, selected for hepatic surgery for colorectal liver metastases by CT and FDG-PET, were evaluated prospectively. During surgery, the liver was assessed by intra-operative ultrasound, palpation and histology. RESULTS: In 127 patients (97%), CT was true-positive for liver metastases. In 3 patients, CT was false-positive and in 1 patient false-negative. In 126 patients (96%), FDG-PET was true-positive for liver metastases, in 2 patients FDG-PET was false-negative, in 3 patients true-negative (negative FDG-PET, false-positive CT). At laparotomy a total of 363 liver metastases was identified: 63 lesions <10 mm [10 (16%) detected by both CT and FDG-PET], 172 lesions of 10-20 mm [123 (72%) CT-positive, 129 (75%) by FDG-PET-positive], and 28 lesions >20 mm [124 (97%) CT-positive, 121 (95%) FDG-PET-positive]. CT and FDG-PET missed approximately 30% of the smaller liver lesions, resulting in a significant change in clinical management during surgery in only nine patients. CONCLUSIONS: CT and FDG-PET have a similar diagnostic yield for the identification of liver metastases; both modalities being adequate on a patient-basis but inadequate to detect the smallest of liver lesions. However, the clinical relevance of the latter is limited. SN - 1068-9265 UR - https://www.unboundmedicine.com/medline/citation/17136470/Comparison_of_multiphase_CT_FDG_PET_and_intra_operative_ultrasound_in_patients_with_colorectal_liver_metastases_selected_for_surgery_ L2 - https://dx.doi.org/10.1245/s10434-006-9259-6 DB - PRIME DP - Unbound Medicine ER -