Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Diagnostic Performance and Prognostic Relevance of FDG Positron Emission Tomography/Computed Tomography for Patients with Extrahepatic Cholangiocarcinoma

  • Nam Hee Kim (Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Sung Ryol Lee (Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Young Hwan Kim (Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hong Joo Kim (Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • Received : 2019.06.15
  • Accepted : 2020.04.23
  • Published : 2020.12.01
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Abstract

Objective: We aimed to evaluate the diagnostic value and prognostic relevance of FDG positron emission tomography/computed tomography (PET-CT) in extrahepatic cholangiocarcinoma patients. Materials and Methods: This study included 234 extrahepatic cholangiocarcinoma patients who underwent FDG PET-CT between June 2008 and February 2016. The diagnostic performance of FDG PEG-CT was compared to that of contrast-enhanced multidetector row CT (MDCT) and MRI. Independent prognosticators for poor survival were also assessed. Results: The sensitivity of FDG PET-CT for detecting primary tumor and regional lymph node metastases was lower than that of MDCT or MRI (p < 0.001), whereas the specificity and positive predictive value for detecting regional lymph nodes metastases was significantly better in FDG PET-CT compared to MDCT and MRI (all p < 0.001). There was no significant difference in the diagnostic yield of distant metastases detection among three diagnostic imaging techniques. In a multivariate analysis, maximum standardized uptake values (SUVmax) of the primary tumor (adjusted hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.13-2.69) and of the metastatic lesions ≥ 5 (adjusted HR, 8.10; 95% CI, 1.96-33.5) were independent contributors to poor overall survival in extrahepatic cholangiocarcinoma patients. In a subgroup analysis of 187 patients with periductal infiltrating type of cholangiocarcinoma, an SUVmax of the primary tumor ≥ 5 was associated with an increased risk of regional lymph node (adjusted odds ratio [OR], 1.60; 95% CI, 0.55-4.63) and distant metastases (adjusted OR, 100.57; 95% CI, 3.94-2567.43) at diagnosis as well as with poor overall survival (adjusted HR, 1.81; 95% CI, 1.04-3.15). Conclusion: FDG PET-CT showed lower sensitivity for detecting primary tumor and regional lymph node involvement than MDCT and MRI. However, the SUVmax of primary tumors and metastatic lesions derived from FDG PET-CT could have significant implications for predicting prognoses in extrahepatic cholangiocarcinoma patients.

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References

  1. Alberts SR, Gores GJ, Kim GP, Roberts LR, Kendrick ML, Rosen CB, et al. Treatment options for hepatobiliary and pancreatic cancer. Mayo Clin Proc 2007;82:628-637 
  2. Keidar Z, Haim N, Guralnik L, Wollner M, Bar-Shalom R, Ben-Nun A, et al. PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 2004;45:1640-1646 
  3. Votrubova J, Belohlavek O, Jaruskova M, Oliverius M, Lohynska R, Trskova K, et al. The role of FDG-PET/CT in the detection of recurrent colorectal cancer. Eur J Nucl Med Mol Imaging 2006;33:779-784 
  4. Bruzzi JF, Munden RF, Truong MT, Marom EM, Sabloff BS, Gladish GW, et al. PET/CT of esophageal cancer: its role in clinical management. Radiographics 2007;27:1635-1652 
  5. Lee SW, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol 2010;45:560-566 
  6. Albazaz R, Patel CN, Chowdhury FU, Scarsbrook AF. Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours. Insights Imaging 2013;4:691-700 
  7. Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, et al. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol 2008;103:1145-1151 
  8. Moon CM, Bang S, Chung JB, Park SW, Song SY, Yun M, et al. Usefulness of 18F-fluorodeoxyglucose positron emission tomography in differential diagnosis and staging of cholangiocarcinomas. J Gastroenterol Hepatol 2008;23:759-765 
  9. Li J, Kuehl H, Grabellus F, Muller SP, Radunz S, Antoch G, et al. Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol 2008;98:438-443 
  10. Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M. Imaging of Cholangiocarcinoma. Visc Med 2016;32:402-410 
  11. Furukawa H, Ikuma H, Asakura-Yokoe K, Uesaka K. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology. Eur Radiol 2008;18:2841-2847 
  12. Kim MS, Kim HJ, Park HW, Kwon HJ, Lee SY, Kook SH, et al. Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment. Ann Surg Treat Res 2017;92:429-435 
  13. Vanderveen KA, Hussain HK. Magnetic resonance imaging of cholangiocarcinoma. Cancer Imaging 2004;4:104-115 
  14. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999;230:808-818; discussion 819 
  15. Siqueira E, Schoen RE, Silverman W, Martin J, Rabinovitz M, Weissfeld JL, et al. Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis. Gastrointest Endosc 2002;56:40-47 
  16. Kato T, Tsukamoto E, Kuge Y, Katoh C, Nambu T, Nobuta A, et al. Clinical role of (18)F-FDG PET for initial staging of patients with extrahepatic bile duct cancer. Eur J Nucl Med Mol Imaging 2002;29:1047-1054 
  17. Furukawa H, Ikuma H, Asakura K, Uesaka K. Prognostic importance of standardized uptake value on F-18 fluorodeoxyglucose-positron emission tomography in biliary tract carcinoma. J Surg Oncol 2009;100:494-499 
  18. Kitamura K, Hatano E, Higashi T, Seo S, Nakamoto Y, Narita M, et al. Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography in patients with extrahepatic bile duct cancer. J Hepatobiliary Pancreat Sci 2011;18:39-46 
  19. Lee JY, Kim HJ, Yim SH, Shin DS, Yu JH, Ju DY, et al. Primary tumor maximum standardized uptake value measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography is a prognostic value for survival in bile duct and gallbladder cancer. Korean J Gastroenterol 2013;62:227-233 
  20. Im HJ, Bradshaw T, Solaiyappan M, Cho SY. Current methods to define metabolic tumor volume in positron emission tomography: which one is better? Nucl Med Mol Imaging 2018;52:5-15 
  21. Moon CM, Bang S, Chung JB. The role of (18) F-fluorodeoxyglucose positron emission tomography in the diagnosis, staging, and follow-up of cholangiocarcinoma. Surg Oncol 2011;20:e10-e17 
  22. Yi HK, Park YJ, Bae JH, Lee JK, Lee KH, Choi SH, et al. Inverse prognostic relationships of 18F-FDG PET/CT metabolic parameters in patients with distal bile duct cancer undergoing curative surgery. Nucl Med Mol Imaging 2018;52:334-341