J Korean Med Sci.  2014 May;29(5):680-684. 10.3346/jkms.2014.29.5.680.

Is There Any Role of Positron Emission Tomography Computed Tomography for Predicting Resectability of Gallbladder Cancer?

• Kim J
• Ryu JK
• Kim C
• Paeng JC
• Kim YT

• KMID: 1786110
• DOI: http://doi.org/10.3346/jkms.2014.29.5.680

Abstract

The role of integrated 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET-CT) is uncertain in gallbladder cancer. The aim of this study was to show the role of PET-CT in gallbladder cancer patients. Fifty-three patients with gallbladder cancer underwent preoperative computed tomography (CT) and PET-CT scans. Their medical records were retrospectively reviewed. Twenty-six patients underwent resection. Based on the final outcomes, PET-CT was in good agreement (0.61 to 0.80) with resectability whereas CT was in acceptable agreement (0.41 to 0.60) with resectability. When the diagnostic accuracy of the predictions for resectability was calculated with the ROC curve, the accuracy of PET-CT was higher than that of CT in patients who underwent surgical resection (P=0.03), however, there was no difference with all patients (P=0.12). CT and PET-CT had a discrepancy in assessing curative resection in nine patients. These consisted of two false negative and four false positive CT results (11.3%) and three false negative PET-CT results (5.1%). PET-CT was in good agreement with the final outcomes compared to CT. As a complementary role of PEC-CT to CT, PET-CT tended to show better prediction about resectability than CT, especially due to unexpected distant metastasis.

Keyword

Gallbladder Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed; Diagnosis

MeSH Terms

Adult
Aged
Aged, 80 and over
*Cholecystography
Female
Fluorodeoxyglucose F18/diagnostic use
Gallbladder/pathology/surgery
Gallbladder Neoplasms/*diagnosis/*surgery
Humans
Lymphatic Metastasis/diagnosis
Male
Middle Aged
Neoplasm Staging
*Positron-Emission Tomography
Radiopharmaceuticals/diagnostic use
Retrospective Studies
Sensitivity and Specificity
*Tomography, X-Ray Computed
Treatment Outcome
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

• 

  Fig. 1 Graph shows receiver operating characteristic curves for resectability. (A) There is no difference of receiver operating characteristic curves between 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (dashed curve) and computed tomography (solid curve) for resectability with all 53 patients. (B) Receiver operating characteristic curves of 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (dashed curve) is better than those of computed tomography (solid curve) for resectability with 26 patients who underwent surgical resection.

Reference

1. National Cancer Control Institute. National Cancer Registration and Statistics in Korea 2010. accessed on 28 Ferbruary 2014. Available at http://ncc.re.kr/english/infor/kccr.jsp.

2. Matsumoto Y, Fujii H, Aoyama H, Yamamoto M, Sugahara K, Suda K. Surgical treatment of primary carcinoma of the gallbladder based on the histologic analysis of 48 surgical specimens. Am J Surg. 1992; 163:239–245.

3. Jarnagin WR, Ruo L, Little SA, Klimstra D, D'Angelica M, DeMatteo RP, Wagman R, Blumgart LH, Fong Y. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003; 98:1689–1700.

4. Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology. 2002; 225:575–581.

5. Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, Bockisch A, Debatin JF, Freudenberg LS. Accuracy of whole-body dual-modality fluorine-18-2-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; 22:4357–4368.

6. Lee JY, Kim HJ, Yim SH, Shin DS, Yu JH, Ju DY, Park JH, Park DI, Cho YK, Sohn CI, et al. Primary tumor maximum standardized uptake value measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography is a prognostic value for survival in bile duct and gallbladder cancer. Korean J Gastroenterol. 2013; 62:227–233.

7. Lee SW, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI. Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol. 2010; 45:560–566.

8. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Gallbladder, AJCC cancer staging manual. 7th ed. New York: Springer;2010. p. 211–217.

9. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960; 20:37–46.

10. Akhurst T, Fong Y. Positron emission tomography in surgical oncology. Adv Surg. 2002; 36:309–331.

11. Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D. Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg. 2004; 8:90–97.

12. Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, Jarnagin WR. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 2008; 206:57–65.

13. Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, Lee SS, Seo DW, Lee SK. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008; 103:1145–1151.

14. Petrowsky H, Wildbrett P, Husarik DB, Hany TF, Tam S, Jochum W, Clavien PA. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol. 2006; 45:43–50.

15. Rodríguez-Fernández A, Gómez-Río M, Llamas-Elvira JM, Ortega-Lozano S, Ferrón-Orihuela JA, Ramia-Angel JM, Mansilla-Roselló A, Martínez-del-Valle MD, Ramos-Font C. Positron-emission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis. Am J Surg. 2004; 188:171–175.

16. Koh T, Taniguchi H, Yamaguchi A, Kunishima S, Yamagishi H. Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine-18-labeled fluoro-deoxyglucose (FDG-PET). J Surg Oncol. 2003; 84:74–81.

17. Kato T, Tsukamoto E, Kuge Y, Katoh C, Nambu T, Nobuta A, Kondo S, Asaka M, Tamaki N. Clinical role of (18)F-FDG PET for initial staging of patients with extrahepatic bile duct cancer. Eur J Nucl Med Mol Imaging. 2002; 29:1047–1054.