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HOME > Ann Coloproctol > Volume 30(1); 2014 > Article
Editorial
 The Role of Positron Emission Tomography/Computed Tomography in the Initial Staging of Colon Cancer
Hyung Jin Kim, Seong Taek Oh1
Annals of Coloproctology 2014;30(1):3-4.
DOI: https://doi.org/10.3393/ac.2014.30.1.3
Published online: February 28, 2014

Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.

1Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Seong Taek Oh, M.D. Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6100, Fax: +82-2-595-2822, stoh@catholic.ac.kr

© 2014 The Korean Society of Coloproctology

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.

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Positron emission tomography (PET) is a functional imaging technique that uses short-lived radioisotopes attached to a tracer to examine abnormal biochemical processes associated with diseases. The most commonly used radiopharmaceutical in PET is 18F-flourodeoxyglucose, which acts as an analogue of glucose and can be used to identify tissues showing increased glucose transport and metabolism, such as cancer cells [1]. PET/computed tomography (CT) is a technique that produces a fused image by combining PET and CT images, which can overcome the drawback of a PET image which lacks fine anatomical definition. However, PET/CT is not helpful for patients with a mucinous carcinoma which has a low metabolic rate, and it cannot differentiate inflammation from cancer tissue.
Accurate initial staging of colon cancer is essential for appropriate treatment. Especially, determining the presence or absence of synchronous distant metastasis is very important because the treatment strategy should be changed according to that result. Estimates of the sensitivity and the specificity of PET/CT in diagnosing liver metastasis are reported to be 87%-100%, and 75%-100%, respectively, which are equal or superior to those reported for contrast-enhanced CT [1-3]. Sometimes, PET/CT may detect another metastasis that has not been found using conventional imaging modalities, and that may change the treatment strategy. However, such cases are not common, and they have been reported to occur in only about 3%-4% of all primary colon cancer patients [4]. Thus, including PET/CT in the routine staging of all patients diagnosed with colon cancer seems to be unreasonable.
If a distant metastasis is suspected in a conventional imaging study such as CT, the role of additional PET/CT is that it can exclude some false positive cases and detect other distant metastases. In those cases, according to the PET/CT results, the treatment strategies may be changed. Thus, it is recommended that PET/CT be performed before deciding the treatment strategy for metastatic colon cancer. As for evaluating lymph-node metastasis, in most of the patients with colon cancer, the treatment strategy is not changed by the clinical status of lymph-node metastasis. Thus, predicting lymph-node metastasis does not have any clinical significance. In addition, the accuracy of predicting lymph-node metastasis is low.
Another role of PET/CT is incidental detection of other diseases, such as stomach cancer, thyroid diseases, and other malignancies. However, in most cases, the discovery of these incidentally-founded diseases does not change the treatment strategy of colon cancer, so it is unreasonable to perform routine PET/CT simply for that reason.
In conclusion, currently, PET/CT is only recommended for the assessment of suspected recurrence of colon cancer and for the assessment of the other distant metastases before resection of metastatic lesions. Furthermore, routine PET/CT is not recommended for initial evaluation of all patients with primary colon cancer. Because cases where some unsuspected metastases or other diseases are found, which may result in a change in the treatment strategy, are rare. Therefore, as the authors mentioned in their conclusion, more studies on selecting patients who might benefit from PET/CT for initial staging are needed [5].
  • 1. Brush J, Boyd K, Chappell F, Crawford F, Dozier M, Fenwick E, et al. The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation. Health Technol Assess 2011;15:1–192. ArticlePDF
  • 2. D'souza MM, Sharma R, Mondal A, Jaimini A, Tripathi M, Saw SK, et al. Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun 2009;30:117–125. ArticlePubMed
  • 3. Kong G, Jackson C, Koh DM, Lewington V, Sharma B, Brown G, et al. The use of 18F-FDG PET/CT in colorectal liver metastases: comparison with CT and liver MRI. Eur J Nucl Med Mol Imaging 2008;35:1323–1329. ArticlePubMed
  • 4. Cipe G, Ergul N, Hasbahceci M, Firat D, Bozkurt S, Memmi N, et al. Routine use of positron-emission tomography/computed tomography for staging of primary colorectal cancer: does it affect clinical management. World J Surg Oncol 2013;11:49.ArticlePubMedPMC
  • 5. Lee JH, Lee MR. Positron emission tomography/couputed tomography in the staging of colon cancer. Ann Coloproctol 2014;30:23–27.ArticlePubMedPMC

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      Oreste Bagni, Luca Filippi, Giuseppe Pelle, Roberto Cianni, Orazio Schillaci
      Cancer Biotherapy and Radiopharmaceuticals.2015; 30(10): 421.     CrossRef

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      The Role of Positron Emission Tomography/Computed Tomography in the Initial Staging of Colon Cancer
      Ann Coloproctol. 2014;30(1):3-4.   Published online February 28, 2014
      DOI: https://doi.org/10.3393/ac.2014.30.1.3
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