AJR Am J Roentgenol 2002 Feb;178(2):353-8
Usefulness of intraoperative sonography for revealing hepatic metastases from
colorectal cancer in patients selected for surgery after undergoing FDG PET.
Rydzewski B, Dehdashti F, Gordon BA, Teefey SA, Strasberg SM, Siegel BA.
OBJECTIVE: The purpose of this study was to compare the diagnostic performance
of preoperative positron emission tomography (PET) with FDG and intraoperative
sonography with the standard of histologic examination of resected liver
specimens in evaluating patients for curative resection of liver metastases from
colorectal cancer. MATERIALS AND METHODS: We retrospectively identified 47
patients with recurrent colorectal cancer who underwent surgical exploration for
possible curative resection of hepatic metastases. All patients underwent CT or
MR imaging and FDG PET preoperatively and intraoperative sonography. The
performance of the imaging techniques was evaluated through review of the
radiologic reports and correlation with surgical and histopathologic findings.
RESULTS: Eighty-seven malignant hepatic lesions were identified by
histopathologic analysis of liver specimens, and 23 benign hepatic abnormalities
were documented histopathologically or by uroradiologic imaging. For hepatic
sections characterized as containing metastases by radiologic imaging, the
positive predictive value for FDG PET was 93% (54/58); for intraoperative
sonography, 87% (52/60); and for conventional imaging, 83% (43/52). For
individual lesions characterized as probably malignant, the positive predictive
value for FDG PET was 93% (62/68); for intraoperative sonography, 89% (63/71);
and for conventional imaging, 78% (46/59). The findings at intraoperative
sonography led to a change in the clinical treatment of only one patient (2%).
CONCLUSION: The results indicate that FDG PET effectively screens potential
candidates for curative liver resection. Although intraoperative sonography
helps to determine the anatomic location of metastases thus facilitating
surgical resection, its adjunctive use in patients screened preoperatively by
FDG PET has limited impact on treatment selection.
