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PET/CT Detects Recurrent Colorectal Cancer

The Challenge: Detecting Recurrent Disease

CT and transrectal ultrasound are standard tools in a preoperative diagnostic workup.
However, CT may fail to demonstrate hepatic metastases and/or extraabdominal metastases, resulting in incorrect staging of the disease.¹

PET/CT Helps Identify Patients Who Are Surgical Candidates

“(FDG-PET) alters patient management in that it enables appropriate selection of patients for different treatments based on accurate results regarding the presence and extent of recurrence.” Arulampalam T, et al ³

PET/CT Effectively Identifies Post-operative Recurrence of Colorectal Cancer

Reveals distant metastases that may render a patient inoperable
Detects local recurrence or resectable metastases

Diagnostic Accuracy of PET/CT in Colorectal Cancer

	SENSITIVITY	SPECIFICITY	NPV	PPV
DX/STAGING
PET	85%²	71%²	99%²	95%²
CT	34%²	92%²	86%²	50%²
RECURRENCE
PET	94%²	87%²	88%²	93%²
CT	79%²	73%²

PET/CT Influenced Patient Management

References
1. Steele G, et al. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Story Group protocol 6584. J Clin Oncol. 1991;9:1105-1112.
2. Gambhir SS, Czernin J, Schwimmer J, Silverman DHS, Coleman RE, Phelps ME. A tabulated summary of the FDG PET literature. J Nucl Med.2001;42(suppl):1S-93S.
3. Arulampalam T, Costa D, Visvikis D, Boulos P, Taylor I, Lee P. The impact of FDG-PET on the management algorithm for recurrent colorectal cancer. Eur J Nucl Med. 2001;28:1758-1765.

Medicare Recognizes the Utility of PET/CT in Colorectal Cancer*

Diagnosis

PET/CT results may assist in avoiding an invasive procedure.
PET/CT may assist in determining the optimal anatomic location to perform an invasive diagnostic procedure**

Staging

When the stage of colorectal cancer remains in doubt after completion of a standard diagnostic workup, including conventional imaging (e.g. MRI, CT, US) or
PET/CT could replace one or more conventional imaging studies when it is expected that the information is insufficient for the clinical management of the patient and
Clinical management of the patient would be different depending on the stage of the colorectal cancer.

Restaging

PET/CT is covered for restaging after the completion of treatment for detecting residual disease, detecting suspected recurrence, or to determine the extent of known recurrence.

* New medical evidence supports the use of PET as a useful tool in determining the presence of hepatic/extrahepatic Metastases in the primary staging of colorectal carcinoma, prior to selecting a treatment regimen. Use of PET is also supported in evaluating recurrent colorectal cancer beyond the limited presentation of a rising CEA level where the patient presents with clinical signs or symptoms of recurrence.

** For most solid tumors a tissue diagnosis is usually performed prior to a PET/CT scan.

PET/CT Reveals Extent of Metastases in Patient with Colorectal Cancer

PET Scan

History
A patient with history of colon cancer and post-chemotherapy treatment presents with rising tumor markers (CEA).

CT Findings
CT findings are negative.

PET Findings
PET/CT scan for recurrence shows two active sites of tumor recurrence in the pelvis.

Change in Treatment
Management reevaluated.

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