Frontiers in surgery · 2026
Preoperative 18F-FDG PET/CT as a surgical triage tool for synchronous neoplasm detection in acute left-sided obstructive colorectal cancer: a two-institution retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Jung Kyung Uk, Lee Sung Ryol, Park Joosung, Kim Hyung Ook, Kim Hungdai, Song Hee-Sung, Lee Ji Young, Kim Yong Bog, Jo Jaemin, Park Ji Eun, Song Hyun Joo, Kim Heung Up, Chang Weon Young, Chun Ho-Kyung, Lee Donghyoun
Аннотация
BACKGROUND AND OBJECTIVE: In acute left-sided obstructive colorectal cancer (OCC), the proximal colon cannot be evaluated endoscopically before surgery, and synchronous colorectal cancers (sCRC) and clinically significant neoplasms (CSN) may remain undetected. We evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for synchronous neoplasm detection in this setting.
METHODS: This retrospective cohort study included 149 consecutive patients with acute left-sided obstructive colorectal adenocarcinoma (splenic flexure through rectum) treated by primary curative resection at two tertiary centers (2007-2016). Postoperative clearing colonoscopy within 6 months served as the reference standard. PET positivity was defined as focal FDG uptake with SUVmax ≥4.0 in a colorectal segment distinct from the index tumor. The primary endpoint was invasive sCRC; the secondary endpoint was CSN.
RESULTS: Median age was 69 years; 71.1% were male. Invasive sCRC was confirmed in 9 patients (6.0%) and CSN in 17 (11.4%). For invasive sCRC, PET/CT showed sensitivity 77.8%, specificity 95.0%, PPV 50.0%, and NPV 98.5%. For CSN, sensitivity was 52.9%, specificity 96.2%, PPV 64.3%, and NPV 94.1%. Among 135 PET-negative patients, 2 (1.5%) harbored invasive sCRC. Secondary curative resection was required in 5 patients (3.4%) and therapeutic endoscopy in 8 (5.4%).
CONCLUSIONS: Preoperative 18F-FDG PET/CT showed a low rate of missed invasive synchronous cancer when negative (1.5%) and identified a subgroup warranting additional intraoperative assessment when positive. PET/CT is not a substitute for clearing colonoscopy and does not mandate extended resection. These findings are exploratory and require prospective validation.
METHODS: This retrospective cohort study included 149 consecutive patients with acute left-sided obstructive colorectal adenocarcinoma (splenic flexure through rectum) treated by primary curative resection at two tertiary centers (2007-2016). Postoperative clearing colonoscopy within 6 months served as the reference standard. PET positivity was defined as focal FDG uptake with SUVmax ≥4.0 in a colorectal segment distinct from the index tumor. The primary endpoint was invasive sCRC; the secondary endpoint was CSN.
RESULTS: Median age was 69 years; 71.1% were male. Invasive sCRC was confirmed in 9 patients (6.0%) and CSN in 17 (11.4%). For invasive sCRC, PET/CT showed sensitivity 77.8%, specificity 95.0%, PPV 50.0%, and NPV 98.5%. For CSN, sensitivity was 52.9%, specificity 96.2%, PPV 64.3%, and NPV 94.1%. Among 135 PET-negative patients, 2 (1.5%) harbored invasive sCRC. Secondary curative resection was required in 5 patients (3.4%) and therapeutic endoscopy in 8 (5.4%).
CONCLUSIONS: Preoperative 18F-FDG PET/CT showed a low rate of missed invasive synchronous cancer when negative (1.5%) and identified a subgroup warranting additional intraoperative assessment when positive. PET/CT is not a substitute for clearing colonoscopy and does not mandate extended resection. These findings are exploratory and require prospective validation.