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J Nucl Med. 2008; 49 (Supplement 1):42P
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General Clinical Specialties: General Practice-Oncology

General PET-CT and Abdominal Malignancies

Tubulovillous/villous adenoma may accumulate more FDG than adenocarcinoma: A diagnostic pitfall in small polypoid lesions of colon

Kai-Yuan Tzen1, Chien-Chuan Chen2 and Han-Mo Chiu2

1 Dept of Nuclear Medicine; 2 Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

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Objectives: The adenomatous polyp of colon is recognized as potential precursor of carcinoma. Several case series observed increased FDG uptake related to polyp size and its degree of dysplasia. This study is aimed to evaluate the potential role of FDG PET/CT scan in separating adenocarcinoma (Ca) from tubulovillous/villous adenoma (TVA) in colon polyps.

Methods: We enrolled 26 asymptomatic health exam volunteers with colorectal polyp found on diagnostic colonoscopy as part of the cancer-screening program. Whole-body FDG PET/CT scan was performed within one week after colonoscopy. Subjects were excluded if they were known with active inflammatory bowel disease or diverticulitis. Therapeutic colonoscopy with polypectomy and/or surgery was done within a week after PET scan. FDG PET findings were then correlated with histopathology.

Results: The study started from March 2006 to September 2007. All lesions are less than 4.5 cm in diameter. FDG PET was positive in 12 Ca and 5 TVAs, negative in 3 Ca and 6 TVAs. The diagnostic sensitivity is 71%, specificity, 66% and accuracy 69% for Ca. The 12 Ca with FDG uptake showed average dimension of 2.6 cm±1.1 cm (mean±SD). The SUVmax measured 8.6±4.0. Only 4/12 (33%) are over 8.5. While the 5 TVAs with FDG uptake showed average dimension to be 2.5 cm±1.0 cm and the SUVmax measured 10.0±1.4. All 5/5 are over 8.5.

Conclusions: In this preliminary series of cases, while using FDG scan in the diagnosis of polypoid lesions less than 4.5 cm in diameter the diagnostic accuracy for Ca is only 69%. In all FDG positive lesions, all of the TVA lesions showed SUVmax over 8.5 while only 66% of the Ca lesions showed SUVmax above 8.5. High SUVmax of lesion may lead to misdiagnosis of Ca.





This Article
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Right arrow Articles by Tzen, K.-Y.
Right arrow Articles by Chiu, H.-M.
PubMed
Right arrow Articles by Tzen, K.-Y.
Right arrow Articles by Chiu, H.-M.