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Change in glucose metabolism measured by 18F-FDG PET/CT as a predictor of histopathologic response to neoadjuvant treatment in rectal cancer

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Abstract

Purpose

In order to analyze the changes of glucose metabolism by maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT in patients with rectal cancer submitted to neoadjuvant radiochemotherapy (nRCT) and to correlate SUV changes with tumor regression grade (TRG).

Methods and material

Three sequential 18F-FDG PET/CT studies were performed in 31 patients with rectal cancer at the following time point: before starting the treatment (PET/CT1), during the treatment (PET/CT2), and after completion of neoadjuvant treatment (PET/CT3). The SUVmax values of the rectal lesion in the PET/CT1 (SUV1), PET/CT2 (SUV2), and PET/CT3 (SUV3) were obtained; deltaSUV1 [(SUV1 − SUV2)/SUV1] and deltaSUV2 [(SUV1 − SUV3)/SUV1] were also calculated. Metabolic parameters were compared to TRG.

Results

Significant differences in pathologic responder and non-responder patients were found only for SUV2 (6.4 ± 2.9 in responder and 10.7 ± 4.8 in non-responder patients, respectively; P = 0.006) and SUV3 (3.6 ± 1.4 in responder and 6.6 ± 2.1 in non-responder patients, respectively; P = 0.0009). The best predictor for TRG response was SUV3 (threshold of 4.4) with sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 77.3%, 88.9%, 80.7%, 61.5%, and 94.4%, respectively.

Conclusion

18F-FDG PET/CT is a reliable and accurate technique to assess the response to nRCT in rectal cancer. In our population, the absolute value of SUVmax after treatment was the best predictor of pathological response.

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Authors and Affiliations

  1. Department of Nuclear Medicine and PET Unit-Molecular Bioimaging Centre, San Gerardo Hospital-University of Milan-Bicocca, 33, via Pergolesi, 20052, Monza, Italy

    Luca Guerra, Giuseppe Di Pisa & Cristina Messa

  2. Department of Radiation Oncology, San Gerardo Hospital-University of Milan-Bicocca, Monza, Italy

    Rita Niespolo, Sara Terrevazzi & Gianstefano Gardani

  3. Department of Radiology, San Gerardo Hospital-University of Milan-Bicocca, Monza, Italy

    Davide Ippolito & Sandro Sironi

  4. Department of Medical Physics, San Gerardo Hospital, Monza, Italy

    Elena De Ponti

  5. Department of Pathology, San Gerardo Hospital-University of Milan-Bicocca, Monza, Italy

    Giorgio Bovo

  6. University of Milan-Bicocca, IBFM-CNR, Monza, Italy

    Cristina Messa

Authors
  1. Luca Guerra
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  2. Rita Niespolo
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  3. Giuseppe Di Pisa
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  9. Gianstefano Gardani
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  10. Cristina Messa
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Correspondence to Cristina Messa.

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Guerra, L., Niespolo, R., Di Pisa, G. et al. Change in glucose metabolism measured by 18F-FDG PET/CT as a predictor of histopathologic response to neoadjuvant treatment in rectal cancer. Abdom Imaging 36, 38–45 (2011). https://doi.org/10.1007/s00261-009-9594-8

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  • DOI: https://doi.org/10.1007/s00261-009-9594-8

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