Onkolojik nedenlerle yapılan PET/CT'de kolorektal bölgelerdeki tesadüfi fokal 18F-FDG tutulumu: Endoskopik bulgularla patolojik korelasyon

Year 2025, Volume: 8 Issue: 1, 109 - 114, 12.01.2025

Selim Demirci , Semih Sezer , Gülin Uçmak Vural , Mahmut Yüksel , Volkan Gökbulut

https://doi.org/10.32322/jhsm.1594127

Abstract

Amaç: Pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/BT) görüntülemesinde kolorektal bölgede görülen rastlantısal fokal 18-florodeoksiglukoz (18F-FDG) tutulumu, adenomlar gibi premalign lezyonları veya maligniteleri işaret edebilir. Erken teşhis ve tanı, kanserin önlenmesi açısından hayati öneme sahiptir. Bu çalışmanın amacı, benign, premalign ve malign lezyonlarla ilişkili rastlantısal fokal kolonik FDG tutulumunun özelliklerini değerlendirmek ve kolonoskopi gerekliliğini belirlemektir.
Yöntemler: Ocak 2019 ile Nisan 2024 tarihleri arasında tüm vücut 18F-FDG PET/BT yapılan, malignite tanısı almış veya şüphesi olan 5.380 hastanın PET/BT raporları retrospektif olarak incelendi. Fokal kolonik 18F-FDG tutulumu gösteren ve ardından kolonoskopiye yönlendirilen hastalar çalışmaya dahil edildi.
Bulgular: Kolonoskopi yapılan 110 hastanın 63’ünde (%57,3) adenom, 14’ünde (%12,7) malign tümör tespit edildi. Maksimum standardize tutulum değeri (SUVmax) üzerinden oluşturulan ROC eğrisi, malign lezyonların malign olmayanlardan ayrılmasında 0.958'lik bir AUC gösterdi. 13,80'lik bir eşik değeri, malign lezyonları ayırt etmek için %92 duyarlılık, %89 özgüllük, %56 pozitif prediktif değer ve %98 negatif prediktif değer sağladı. SUVmax, maligniteyi diğer kolonoskopik bulgulardan anlamlı şekilde ayırt etti (P < .001). Adenomlar ile benign veya fizyolojik bulgular arasında ise anlamlı fark bulunamadı (P > .05).
Sonuç: Kolonoskopi sonuçları, malign lezyonların diğer lezyon türlerine veya fizyolojik tutuluma kıyasla anlamlı derecede yüksek SUVmax değerlerine sahip olduğunu gösterdi. Bununla birlikte, SUVmax değeri, benign lezyonları adenomlardan ayırt etmek için yeterli olmadı. Bu nedenle, rastlantısal kolonik bulguların tümü dikkatlice değerlendirilmelidir ve SUVmax ≥ 13,80 olan lezyonlar için hızla inceleme planlanmalıdır.

Keywords

PET/CT, fokal tutulum, SUVmax, kolonoskopi, malignite

Incidental focal 18F-FDG uptake in colorectal locations on PET/CT for oncologic reasons: pathologic correlation with endoscopic findings

Abstract

Aims: Incidental focal 18-fluorodeoxyglucose (18F-FDG) uptake in the colorectal region on positron emission tomography/computed tomography (PET/CT) may indicate premalignant lesions, such as adenomas or malignancies. Early detection and diagnosis are crucial for cancer prevention. This study aimed to assess the characteristics of incidental focal colonic FDG uptake associated with benign, premalignant, and malignant lesions, and to determine when colonoscopy is necessary.
Methods: A retrospective review of PET/CT reports was conducted on 5.380 patients with confirmed or suspected malignancies who underwent whole-body 18F-FDG PET/CT between January 2019 and April 2024. Patients exhibiting focal colonic 18F-FDG uptake and subsequently referred for colonoscopy were included in this study.
Results: Among 110 patients who underwent colonoscopy, 63 (57.3%) had adenomas and 14 (12.7%) had malignant tumors. The receiver operating characteristic (ROC) curve based on the maximum standardized uptake value (SUVmax) showed an AUC of 0.958. A cutoff value of 13.80 was optimal for distinguishing malignant lesions from nonmalignant lesions, with a sensitivity of 92%, specificity of 89%, positive predictive value of 56%, and negative predictive value of 98%. The SUVmax significantly differentiated malignancy from other colonoscopic findings (p<0.001). No significant differences were observed between adenomas and benign or physiological findings (p>0.05).
Conclusion: The colonoscopy results indicated that malignant lesions had significantly elevated SUVmax values compared to other lesion types or physiological uptake. However, the SUVmax was not sufficient to distinguish benign lesions from adenomas. Therefore, all incidental colonic findings should be thoroughly assessed, and lesions with SUVmax ≥13.80 should be promptly evaluated.

Keywords

PET/CT, focal uptake, SUVmax, colonoscopy, malignancy

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