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Journal of Cancer Research and Clinical Oncology

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01-02-2015 | Original Article – Clinical Oncology

Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer

Authors: Jung Wook Huh, Seong Young Kwon, Jae Hyuk Lee, Hyeong Rok Kim

Published in: Journal of Cancer Research and Clinical Oncology | Issue 2/2015

Abstract

Purpose

The aim of this study was to compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation.

Methods

One hundred and eighty-one consecutive patients with locally advanced rectal cancer who underwent a total mesorectal excision after preoperative chemoradiation were prospectively enrolled. All the patients underwent FDG-PET/CT and pelvic MRI before chemoradiation and 5 weeks after the completion of chemoradiation. We evaluated the measurements of the FDG uptake (SUV_max) and the percentage of SUV_max difference (Response Index = RI) between the pre- and postchemoradiation FDG-PET/CT scans. The accuracy of repeat FDG-PET/CT and pelvic MRI for predicting pathologic CR were compared.

Results

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2 %, respectively. In terms of FDG-PET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6 % as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1 %, a specificity of 64.5 %, a PPV of 25.7 %, a NPV of 93.5 %, and an accuracy of 65.7 % (area under the curve = 0.723, 95 % confidence interval 0.619–0.828, P < 0.001).

Conclusions

The accuracy of FDG-PET/CT restaging is superior to that of MRI staging for predicting pathologic CR in irradiated rectal cancer. An NPV of 93.5 % indicates that FDG-PET/CT can rule out the pathologic CR.

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Title: Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer
Authors: Jung Wook Huh
Seong Young Kwon
Jae Hyuk Lee
Hyeong Rok Kim
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 2/2015
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-014-1815-z

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Abstract

Purpose

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Conclusions

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