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Diagnostic accuracy of F-18 FDG PET/CT for characterization of colorectal focal FDG uptake: a systematic review and meta-analysis

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Abstract

Introduction

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for characterization of incidental colorectal focal FDG uptake through a systematic review and meta-analysis.

Methods

The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves.

Results

Across 8 studies (1451 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.87 (95% CI 0.82–0.90) without heterogeneity (χ2 = 10.84, p = 0.37) and a pooled specificity of 0.83 (95% CI 0.76–0.89) with heterogeneity (χ2 = 130.1, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.2 (95% CI 3.6–7.4) and negative likelihood ratio (LR−) of 0.16 (95% CI 0.12–0.22). The pooled DOR was 32 (95% CI 20–51).

Conclusion

F-18 FDG PET/CT demonstrated good sensitivity and specificity for characterization of incidental colorectal focal FDG uptake. At present, the literature regarding the use of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET/CT for characterization of incidental colorectal focal FDG uptake.

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References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30

    Article  PubMed  Google Scholar 

  2. Leslie A, Carey FA, Pratt NR, Steele RJ (2002) The colorectal adenoma-carcinoma sequence. Br J Surg 89:845–860

    Article  PubMed  CAS  Google Scholar 

  3. Atkin WS, Saunders BP (2002) Surveillance guidelines after removal of colorectal adenomatous polyps. Gut 51(Suppl V):V6–V9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Blodgett TM, Meltzer CC, Townsend DW (2007) PET/CT: form and function. Radiology 242:360–385

    Article  PubMed  Google Scholar 

  5. Czernin J, Allen-Auerbach M, Schelbert HR (2007) Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med 48:78–88

    Google Scholar 

  6. Bar-Shalom R, Yefremov N, Guralnik L, et al. (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 44:1200–1209

    PubMed  Google Scholar 

  7. Lonneux M (2008) FDG-PET and PET/CT in colorectal cancer. PET Clin 3:147–153

    Article  PubMed  Google Scholar 

  8. Kantorová I, Lipská L, Bêlohlávek O, et al. (2003) Routine 18F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. J Nucl Med 44:1784–1788

    PubMed  Google Scholar 

  9. Israel O, Yefremov N, Bar-Shalom R, et al. (2005) PET/CT detection of unexpected gastrointestinal foci of 18F-FDG uptake: incidence, localization patterns, and clinical significance. J Nucl Med 46:758–762

    PubMed  Google Scholar 

  10. Jadvar H, Schambye RB, Segall GM (1999) Effect of atropine and sincalide on the intestinal uptake of F-18 fluorodeoxyglucose. Clin Nucl Med 24:965–967

    Article  PubMed  CAS  Google Scholar 

  11. Abdel-Nabi H, Doerr RJ, Lamonica DM, et al. (1998) Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 206:755–760

    Article  PubMed  CAS  Google Scholar 

  12. Meyer MA (1995) Diffusely increased colonic F-18 FDG uptake in acute enterocolitis. Clin Nucl Med 20:434–435

    Article  PubMed  CAS  Google Scholar 

  13. Weston BR, Iyer RB, Qiao W, et al. (2010) Ability of integrated positron emission and computed tomography to detect significant colonic pathology: the experience of a tertiary cancer center. Cancer 116:1454–1461

    Article  PubMed  Google Scholar 

  14. Kei PL, Vikram R, Yeung HW, Stroehlein JR, Macapinlac HA (2010) Incidental finding of focal FDG uptake in the bowel during PET/CT: CT features and correlation with histopathologic results. AJR 194:W401–W406

    Article  PubMed  Google Scholar 

  15. Oh JR, Min JJ, Song HC, et al. (2012) A stepwise approach using metabolic volume and SUVmax to differentiate malignancy and dysplasia from benign colonic uptakes on 18F-FDG PET/CT. Clin Nucl Med 37:e134–e140

    Article  PubMed  Google Scholar 

  16. Shie P (2011) Incidental focal hypermetabolic colorectal lesions identified by positron emission tomography: prevalence of malignancy. Abdom Imaging 36:165–169

    Article  PubMed  Google Scholar 

  17. Luboldt W, Volker T, Wiedemann B, et al. (2010) Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off. Eur Radiol 20:2274–2285

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chen YK, Kao CH, Liao AC, Shen YY, Su CT (2003) Colorectal cancer screening in asymptomatic adults: the role of FDG PET scan. Anticancer Res 23:4357–4361

    PubMed  Google Scholar 

  19. Tatlidil R, Jadvar H, Bading JR, Conti PS (2002) Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology 224:783–787

    Article  PubMed  Google Scholar 

  20. Lee ST, Tan T, Poon AM, et al. (2008) Role of low-dose, noncontrast computed tomography from integrated positron emission tomography/computed tomography in evaluating incidental 2-deoxy-2-[F-18]fluoro-d-glucose-avid colon lesions. Mol Imaging Biol 10:48–53

    Article  PubMed  CAS  Google Scholar 

  21. Kousgaard SJ, Thorlacius-Ussing O (2017) Incidental colorectal FDG uptake on PET/CT scan and lesions observed during subsequent colonoscopy: a systematic review. Tech Coloproctol 21:521–529

    Article  PubMed  CAS  Google Scholar 

  22. Treglia G, Taralli S, Salsano M, et al. (2014) Prevalence and malignancy risk of focal colorectal incidental uptake detected by 18F-FDG-PET or PET/CT: a meta-analysis. Radiol Oncol 48:99–104

    Article  PubMed  PubMed Central  Google Scholar 

  23. Whiting PF, Rutjes AW, Westwood ME, et al. (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536

    Article  PubMed  Google Scholar 

  24. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135

    Article  PubMed  Google Scholar 

  25. Thompson SG (1994) Why sources of heterogeneity in meta-analysis should be investigated. BMJ 309:1351–1355

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893

    Article  PubMed  Google Scholar 

  27. Reitsma JB, Glas AS, Rutjes AW, et al. (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990

    Article  PubMed  Google Scholar 

  28. Hamza TH, van Houwelingen HC, Stijnen T (2008) The binomial distribution of meta-analysis was preferred to model within-study variability. J Clin Epidemiol 61:41–51

    Article  PubMed  Google Scholar 

  29. Rutter CM, Gatsonis CA (2001) A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20:2865–2884

    Article  PubMed  CAS  Google Scholar 

  30. Lijmer JG, Mol BW, Heisterkamp S, et al. (1999) Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 282:1061–1066

    Article  PubMed  CAS  Google Scholar 

  31. Choi BW, Kim HW, Won KS, et al. (2016) Diagnostic accuracy of 18F-FDG PET/CT for detecting synchronous advanced colorectal neoplasia in patients with gastric cancer. Medicine 95:e4741

    Article  PubMed  PubMed Central  Google Scholar 

  32. Soltau SR, Hess S, Nguyen T, et al. (2016) Clinical significance of incidental focal bowel uptake on 18F-FDG PET/CT as related to colorectal cancer. Hell J Nucl Med 19:245–249

    PubMed  Google Scholar 

  33. van Hoeij FB, Keijsers RG, Loffeld BC, et al. (2015) Incidental colonic focal FDG uptake on PET/CT: can the maximum standardized uptake value (SUVmax) guide us in the timing of colonoscopy? Eur J Nucl Med Mol Imaging 42:66–71

    Article  PubMed  Google Scholar 

  34. Na SY, Kim KJ, Han S, et al. (2015) Who should undergo a colonoscopy among patients with incidental colon uptake on PET-CT? Scand J Gastroenterol 50:1045–1053

    Article  PubMed  Google Scholar 

  35. Cho SH, Kim SW, Kim WC, et al. (2013) Incidental focal colorectal 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography. World J Gastroenterol 19:3453–3458

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Liu T, Behr S, Khan S, Osterhoff R, Aparici CM (2015) Focal colonic FDG activity with PET/CT: guidelines for recommendation of colonoscopy. World J Nucl Med 14:25–30

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lee C, Koh SJ, Kim JW, et al. (2013) Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon? Dig Dis Sci 58:229–235

    Article  PubMed  Google Scholar 

  38. Drenth JP, Nagengast FM, Oyen WJ (2001) Evaluation of (pre-) malignant colonic abnormalities: endoscopic validation of FDG-PET findings. Eur J Nucl Med 28:1766–1769

    Article  PubMed  CAS  Google Scholar 

  39. Engel H, Steinert H, Buck A, et al. (1996) Whole-body PET: physiological and artifactual fluorodeoxyglucose accumulations. J Nucl Med 37:441–446

    PubMed  CAS  Google Scholar 

  40. Strauss LG (1996) Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 23:1409–1415

    Article  PubMed  CAS  Google Scholar 

  41. Even-Sapir E, Lerman H, Gutman M, et al. (2006) The presentation of malignant tumors and pre-malignant lesions incidentally found on PET-CT. Eur J Nucl Med Mol Imaging 33:541–552

    Article  PubMed  Google Scholar 

  42. Gutman F, Alberini JL, Wartski M, et al. (2005) Incidental colonic focal lesions detected by FDG PET/CT. Am J Roentgenol 185:495–500

    Article  Google Scholar 

  43. Pandit-Taskar N, Schöder H, Gonen M, Larson SM, Yeung HW (2004) Clinical significance of unexplained abnormal focal FDG uptake in the abdomen during whole-body PET. AJR 183:1143–1147

    Article  PubMed  Google Scholar 

  44. Ozkol V, Alper E, Aydin N, et al. (2010) The clinical value of incidental 18F-fluorodeoxyglucose-avid foci detected on positron emission tomography/computed tomography. Nucl Med Commun 31:128–136

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by a 2-Year Research Grant of Pusan National University.

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Authors and Affiliations

  1. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, 50612, Korea

    Gyung Mo Son

  2. BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Korea

    Gyung Mo Son & Seong-Jang Kim

  3. Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Korea

    Seong-Jang Kim

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  1. Gyung Mo Son
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Correspondence to Seong-Jang Kim.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Institutional review board approval was not required because we only performed data analysis based on the published studies.

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Written informed consent was not required for this study because it is a meta-analysis based on the studies that have been published.

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Son, G.M., Kim, SJ. Diagnostic accuracy of F-18 FDG PET/CT for characterization of colorectal focal FDG uptake: a systematic review and meta-analysis. Abdom Radiol 44, 456–463 (2019). https://doi.org/10.1007/s00261-018-1747-1

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