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Introduction
During the initial TNM staging of cancer patients a PET CT investigation can be of great value. Incidental colon standardized uptake value (SUV) enhancements are often visible and described. This recommendation is often link with a recommendation for a colonoscopy. Our goal was to assess the relevance of a coloscopic workup of incidental colorectal FDG-avid lesions.
Material and methods
We performed a retrospective analysis of all PET/CT-reports (n=2300), which have been generated in our nuclear medicine institution since the implementation (between May 2006 and 2008) of a PET/CT-hybrid-scanner (GE Discovery STE). Patients with primary colorectosigmoidal malignancies were excluded. The SUVmax of ≥5 was based on experience and current literature. Based on this value a colonoscopy was recommended in 48 cases. Based on these recommendations 21 colonoscopies were performed.
Results
The SUVmax-values, where a colonoscopy was recommended ranged from 5.3 to 42.0. In 20 out of the 21 patients a histopathologic abnormality was found in the location prediscribed in PET/CT (2 carcinomas, 1 grave epithel-dysplasia, 13 adenomas, 4 polyps); 9 patients had additional coloscopic findings (8 adenomas, 1 grave epithel-dysplasia, 2 polyps). One patient had a normal colonoscopy.
Conclusion
A SUVmax cutoff ≥5 has proven to be highly specific for pathological findings. Incidental findings of focal colorectal FDG-uptake have very high correlation with pathological findings. In cancer patients with reasonable life expectation a coloscopic workup should be performed.