Clinical value of whole-body positron emission tomography in potentially curable colorectal liver metastases

Aims In selected patients with colorectal liver metastases, hepatic resection offers an opportunity for cure, with a 25–38% 5-year survival rate. The aim of this prospective study was to evaluate whether patient selection could be improved with pre-operative whole-body 18-fluoro-2-deoxyglucose–positron emission tomography (FDG–PET) scan. Methods Ninety-one consecutive patients were considered to be eligible for liver resection after investigation with conventional diagnostic methods (CDM). In all these patients a whole-body PET scan with FDG was performed prior to surgery. Follow-up was complete with a mean of 23 months (2 weeks–92 months). All PET images were reviewed blinded to intraoperative and follow-up data. Results PET confirmed liver metastases in 90 (99%) patients, while it provided additional information in 10 (11%) patients, i.e. seven intra-abdominal, and three extra-abdominal. PET falsely upstaged six (6.6%) patients in whom malignancy was excluded by additional investigation, at the time of surgery, or during follow-up. PET falsely understaged seven (7.7%) patients with small intra-abdominal lesions. Conclusion In patients with potentially curable colorectal liver metastases according to conventional diagnostic methods, whole-body FDG–PET can be considered as a complementary examination in order to further select patients for potentially curative liver resection, and to optimize therapeutic strategy.