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Usefulness of Intraoperative Sonography for Revealing Hepatic Metastases from Colorectal Cancer in Patients Selected for Surgery After Undergoing FDG PET

¹ Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
² Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110.
³ Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110.

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.

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