Veysel HAKSÖYLER, Tolga KÖŞECİ, Ertuğrul BAYRAM, Polat OLGUN, Mehmet Ali ÇAPARLAR

Kolon Karsinomunun Preoperatif Lenf Nodu Evrelemesinde Pet-Bt’nin Etkinliği

Giriş: Erken evre Kolon kanserinde en önemli prognostik belirteç bölgesel Lenf Nodu (LN) metastazı durumudur. Ayrıca uygun tedavi planının yapılabilmesinin en önemli şartı da tam evrelemenin yapılmış olmasıdır. Amaç: Çalışmamızda erken evre Kolon kanserinde preoperatif Pozitron Emisyon Tomografisi (PET/BT)’nin bölgesel LN’ları ile ilşkisini incelemeyi amaçladık. Yöntemler: Kliniğimizde Mart 2014 ve Temmuz 2019 tarihleri arasında tedavi ettiğimiz 83 erken evre Kolon kanseri hastasının verilerini retrospektif olarak analiz ettik. Preoperatif PET/BT bulguları ile Patolojik evrelemedeki bulguları karşılaştırdık Bulgular: Erken evre Kolon kanserinde PET/BT’nin LN metastazını göstermede sensitivite, spesifite ve doğruluk oranını sırasıyla %66,7, %64 ve %65,1 olarak belirledik. Tartışma: Çalışmamıza göre erken evre kolon kanserinde PET/BT’nin LN metastazını göstermedeki sensitivite ve spesifitesi tatmin edici olmaktan uzaktır. Sonuç: Konu ile ilgili yayınlanmış çalışmalarda genel olarak kolon ve rektum kanserli hastalar beraber incelenmiştir. Çalışmamızda sadece Kolon kanserli hastalar incelendiğinde hasta grubu olarak daha homojendir. Bu bakımdan literatüre katkı sunabileceğimizi düşünüyoruz.

The Impact Of Fdg Pet/Ct In Preoperative Lymph Node Staging Of New Diagnosed Colon Carcinoma

Objective: The most important prognostic factor in early stage Colon Cancer is Lypmh Node (LN) metastasis. In addition, staging is the most important condition for appropriate treatment plan. Therefore, the presence of LN metastasis at the time of diagnosis has a critical role in terms of both correct staging and correct treatment and determining the prognosis. Aim: We aimed to determine the effectiveness of preoperative PET/CT for showing Lymph node metastasis in early stage Colon Cancer Methods: In our study, we retrospectively analyzed the information of 83 early-stage Colon Cancer patients treated in our clinic between 2014 and 2019. Preoperative PET / CT compared with their pathological stages Results: We determined the sensitivity, specificity and accuracy of PET/CT in early stage colon cancer for showing Lymph node metastasis as respectively 66,7%, 64%, 65,1% Discussion: In our study, we did not find satisfactory the sensitivity and specificity of PET/CT for lymph node staging in early stage colon cancer. We found that PET/CT is not more useful than conventional methods in the initial staging of early-stage colon cancer. Therefore, we think that it is more rational to use PET / CT for systemic screening in the initial staging of Colon Cancer or for suspicious lesions. Conclusion: We believe that our study can contribute to the literature in this regard, as it includes a homogeneous patient group with Colon Cancer, but it should be supported by other studies with larger series.

PDF

___

1. Siegel R,Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011.
2. https://www.cancer.net/cancertypes/ colorectal-cancer/statistics.
3. Jessup JM, Goldberg RM, Aware EA, et al. Colon and Rectum. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), AJCC, Chicago 2017. p.251.
4. O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004; 96: 1420–5.
5. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
6. Shin SS, Jeong YY, Min JJ et al (2008) Preoperative staging ofcolorectal cancer: CT versus integrated FDG PET/CT. Abdom Imaging 33: 270–7.
7. Rosenbaum S J, L ind T , A ntoch G , e t a l. F alsepositive FDG uptake- the role of PET/CT. Eur Radiol 2006;16:1054e65.
8. Abdul Jalil Nordin, Hairil Rashmizal , Noraini Abdul Rahim , Claudio Rossetti. Potential false positive active extra pulmonary tuberculosis lesions on FDG PET/CT imaging in malignancy. Dicle Tıp Derg / Dicle Med J Cilt/Vol 37, No 1, 42-7.
9. Antoch G, Saoudi N, Kuehl H, et al. Accuracy of whole-body dual-modality fluorine- 18e2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357e68.
10. Tzimas GN, Koumanis DJ, Meteressian S. Positron emission tomography and colorectal carcinoma: an update. J Am Coll Surg 2004;198:645e52.
11. Herbertson RA, Scarsbrook AF, Lee ST, et al. Established, emerging and future rolesof PET/CT in the management of colorectal cancer. Clin Radiol 2008;64:225e37.
12. Topal B, Flamen P, Aerts R, et al. Clinical value of whole-body emission tomography in potentially curable colorectal liver metastases. Eur J Surg Oncol 2001; 27: 175e9.
13. Yu-Yu L, Jin-Hua C, Hueisch-Jy D, et al. A systematic review and meta-analysis of pretherapeutic lymph node staging of colorectal cancer by 18F-FDG PET or PET/CT. Nuclear Medicine Communications 2012, Vol 33 No 11.
14. Jae Young K, Jae Seung K, H ye J in K , et al. Diagnostic Value of FDG-PET/CT for Lymph Node Metastasis of Colorectal Cancer World J Surg (2012) 36:1898–1905 DOI 10.1007/s00268-012-1575-3.
15. Ukihide T, Tetsuo M, Tsuyoshi M, Mototaka M, Yasuaki A, E. Edmund K. Non-enhanced CT versus contrast-enhanced CT in integrated PET/CT studies for nodal staging of rectal cancer. Eur J Nucl Med Mol Imaging (2007) 34: 1627–1634 DOI 10.1007/s00259-007-0455-9.
16. Abdel-Nabi H, Doerr RJ, Lamonica DM, et al. Staging of primary colorectal carcinoma with Fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998;206:755e60.
17. Kantorova I, Lipska L, Belohlavek O, et al. Routine 18F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on decision making. J Nucl Med 2003; 44: 1784e8.
18. Dighe S, Swift I, Brown G. CT staging of colon cancer. Clin Radiol 2008;63:1372e9.... Bipat S, Glas AS, Slovs FJM, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT and MR imaging- a metaanalysis. Radiology 2004; 232: 773e83.
19. Klessen C, Rogalla P, Taupitz M. Local staging of rectal cancer: the current role of MRI. Eur Radiol 2007; 17: 379e89.
20. Furukawa H, Ikuma H, Seki A, et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut 2006; 55: 1007e11.
21. Jung Sub So, Chinock Cheong, Seung Yeop Oh, Jei Hee Lee,1 Young Bae Kim,2 and Kwang Wook Suh. Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center. Ann Coloproctol. 2017 Oct; 33: 192–6.
22. Sarı R., Durak D., Yazıcıoğlu M. Ö., Gürer A. The Role of Computed Tomography for the Detection of Lymph Node in Colon Cancers. Bozok Med J 2019; 9: 48-51.