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Incidental Colonic 18F-Fluorodeoxyglucose Uptake: Do We Need Colonoscopy for Patients with Focal Uptake Confined to the Left-Sided Colon?

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Abstract

Background/Aims

Although access to [18F]2-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography and computed axial tomography (PET/CT) for patients with malignancy has increased, little information is available on the suitability of PET/CT for diagnosis of advanced colonic neoplasms in oncology patients and on the clinical significance of incidental 18F-FDG focal uptake confined to the left-sided colon.

Methods

Patients who underwent 18F-FDG PET/CT followed, within 90 days, by colonoscopy were identified. Case–control analysis was undertaken to determine whether focal 18F-FDG uptake confined to the left-sided colon was associated with advanced neoplasms in the right-sided colon.

Results

One hundred ninety-five patients with colonic 18F-FDG uptake and 561 without colonic 18F-FDG uptake were identified. Of the 195 patients with focal colonic 18F-FDG activity, 103 patients (52.8 %) had 145 advanced colonic neoplasms, including 58 colon cancers and 11 metastatic cancers. In the detection of advanced colonic neoplasms, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were 54.4, 82.4, 46.9, and 86.3 %, respectively. Overall accuracy was 76.2 %. Ten (8.0 %) of the 125 patients with focal 18F-FDG uptake confined to the left-sided colon had three colon cancers and seven advanced adenomas in the right-sided colon. Case–control analysis revealed that focal 18F-FDG uptake confined to the left-sided colon was associated with an advanced neoplasms in the right-sided colon (OR, 3.02; 95 % CI, 1.12–8.13; P = 0.023).

Conclusions

Colonic focal 18F-FDG uptake by oncology patients warrants endoscopic verification. Complete colon evaluation by colonoscopy is required, even for patients with focal 18F-FDG uptake confined to the left-sided colon.

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Changhyun Lee, Jong Pil Im, Sang Gyun Kim, Joo Sung Kim & Hyun Chae Jung

  2. Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul, 156-707, Korea

    Seong-Joon Koh, Ji Won Kim, Kook Lae Lee & Byeong Gwan Kim

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  1. Changhyun Lee
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  2. Seong-Joon Koh
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  3. Ji Won Kim
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  4. Kook Lae Lee
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  9. Byeong Gwan Kim
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Correspondence to Byeong Gwan Kim.

Additional information

Changhyun Lee and Seong-Joon Koh contributed equally to this article.

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Lee, C., Koh, SJ., Kim, J.W. et al. Incidental Colonic 18F-Fluorodeoxyglucose Uptake: Do We Need Colonoscopy for Patients with Focal Uptake Confined to the Left-Sided Colon?. Dig Dis Sci 58, 229–235 (2013). https://doi.org/10.1007/s10620-012-2333-y

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  • DOI: https://doi.org/10.1007/s10620-012-2333-y

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