J Cancer Res Clin Oncol (2015) 141:353–359 DOI 10.1007/s00432-014-1815-z
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Comparison of restaging accuracy of repeat FDG‑PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer Jung Wook Huh · Seong Young Kwon · Jae Hyuk Lee · Hyeong Rok Kim
Received: 11 August 2014 / Accepted: 26 August 2014 / Published online: 3 September 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose The aim of this study was to compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDGPET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation. Methods One hundred and eighty-one consecutive patients with locally advanced rectal cancer who underwent a total mesorectal excision after preoperative chemoradiation were prospectively enrolled. All the patients underwent FDG-PET/CT and pelvic MRI before chemoradiation and 5 weeks after the completion of chemoradiation. We evaluated the measurements of the FDG uptake (SUVmax) and the percentage of SUVmax difference (Response Index = RI) between the pre- and postchemoradiation FDG-PET/CT scans. The accuracy of repeat FDG-PET/ CT and pelvic MRI for predicting pathologic CR were compared.
J. W. Huh Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S. Y. Kwon Department of Nuclear Medicine, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea J. H. Lee Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea H. R. Kim (*) Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang‑ro, Hwasun‑Eup, Hwasun‑Gun, Gwangju, Jeollanam‑do 519‑763, Korea e-mail: [email protected]
Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2 %, respectively. In terms of FDGPET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6 % as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1 %, a specificity of 64.5 %, a PPV of 25.7 %, a NPV of 93.5 %, and an accuracy of 65.7 % (area under the curve = 0.723, 95 % confidence interval 0.619–0.828, P 2; history of type I diabetes; 5 cm Pretreatment stage II III Operation type Low anterior resection Abdominoperineal resection Pathologic stage 0 (complete response) I II
66 (28–82) 128:53 105 (58.0) 76 (42.0) 50 (27.6) 131 (72.4) 159 (87.8) 22 (12.2) 26 (14.4) 47 (26.0) 63 (34.8)
III
45 (24.8)
Table 2 Association between the restaging after preoperative chemoradiation by a repeat pelvic MRI and pathologic staging Restaging
Pathologic staging 0 (CR)
I
II
III
Total
0 (CR) I II III
10 (38.5) 6 (23.1) 7 (26.9) 3 (11.5)
13 (27.7) 10 (21.3) 16 (34.0) 8 (17.0)
2 (3.2) 6 (9.5) 36 (57.1) 19 (30.2)
3 (6.7) 4 (8.9) 10 (22.2) 28 (62.2)
28 26 69 58
Total
26
47
63
45
CR complete response
13
356
J Cancer Res Clin Oncol (2015) 141:353–359
Table 3 Correlations between the response index (RI) and the clinicopathologic variables Low RIa (n = 107) Age, years
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Comparison of restaging accuracy of repeat FDG‑PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer Jung Wook Huh · Seong Young Kwon · Jae Hyuk Lee · Hyeong Rok Kim
Received: 11 August 2014 / Accepted: 26 August 2014 / Published online: 3 September 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose The aim of this study was to compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDGPET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation. Methods One hundred and eighty-one consecutive patients with locally advanced rectal cancer who underwent a total mesorectal excision after preoperative chemoradiation were prospectively enrolled. All the patients underwent FDG-PET/CT and pelvic MRI before chemoradiation and 5 weeks after the completion of chemoradiation. We evaluated the measurements of the FDG uptake (SUVmax) and the percentage of SUVmax difference (Response Index = RI) between the pre- and postchemoradiation FDG-PET/CT scans. The accuracy of repeat FDG-PET/ CT and pelvic MRI for predicting pathologic CR were compared.
J. W. Huh Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S. Y. Kwon Department of Nuclear Medicine, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea J. H. Lee Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea H. R. Kim (*) Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang‑ro, Hwasun‑Eup, Hwasun‑Gun, Gwangju, Jeollanam‑do 519‑763, Korea e-mail: [email protected]
Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2 %, respectively. In terms of FDGPET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6 % as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1 %, a specificity of 64.5 %, a PPV of 25.7 %, a NPV of 93.5 %, and an accuracy of 65.7 % (area under the curve = 0.723, 95 % confidence interval 0.619–0.828, P 2; history of type I diabetes; 5 cm Pretreatment stage II III Operation type Low anterior resection Abdominoperineal resection Pathologic stage 0 (complete response) I II
66 (28–82) 128:53 105 (58.0) 76 (42.0) 50 (27.6) 131 (72.4) 159 (87.8) 22 (12.2) 26 (14.4) 47 (26.0) 63 (34.8)
III
45 (24.8)
Table 2 Association between the restaging after preoperative chemoradiation by a repeat pelvic MRI and pathologic staging Restaging
Pathologic staging 0 (CR)
I
II
III
Total
0 (CR) I II III
10 (38.5) 6 (23.1) 7 (26.9) 3 (11.5)
13 (27.7) 10 (21.3) 16 (34.0) 8 (17.0)
2 (3.2) 6 (9.5) 36 (57.1) 19 (30.2)
3 (6.7) 4 (8.9) 10 (22.2) 28 (62.2)
28 26 69 58
Total
26
47
63
45
CR complete response
13
356
J Cancer Res Clin Oncol (2015) 141:353–359
Table 3 Correlations between the response index (RI) and the clinicopathologic variables Low RIa (n = 107) Age, years
