RESUMO
El cáncer colorrectal es el tercer cáncer en frecuencia a nivel mundial. Aunque su incidencia está aumentando, fundamentalmente en menores de 50 años, su mortalidad ha disminuido un 50% en los países más desarrollados, principalmente debido a la adopción de nuevas prácticas en la prevención, diagnóstico y tratamiento. En particular, las diversas modalidades de diagnóstico por imagen permiten mejorar la toma de decisiones terapéuticas, la evaluación de la respuesta y la eficacia de las nuevas terapias y la detección precoz de la recidiva. La finalidad del presente trabajo es hacer una revisión de la evidencia científica disponible sobre el valor de la tomografía por emisión de positrones con 18F-FDG (18F-FDG PET/TC) en el cáncer colorrectal, haciendo especial hincapié en las indicaciones de las guías y recomendaciones de las principales asociaciones científicas internacionales respecto a esta técnica de imagen
Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under 50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique
Assuntos
Humanos , Carcinoma/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Carcinoma/patologia , Carcinoma/terapia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Tomografia Computadorizada de Emissão/métodosRESUMO
Objective. To determine the effectiveness of whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) in detecting metastases by comparing the results with those from choline-positron emission tomography-computed tomography (choline-PET/CT) in patients with biochemical relapse after primary treatment, and no metastases in bone scintigraphy, CT and/or pelvic MRI, or metastatic/oligometastatic prostate cancer (PCa). Patients with this disease profile who could benefit from treatment with stereotactic body radiation therapy (SBRT) were selected and their responses to these techniques were rated. Materials and methods. This was a prospective, controlled, unicentric study, involving 46 consecutive patients from our centre who presented biochemical relapse after adjuvant, salvage or radical treatment with external beam radiotherapy, or brachytherapy. After initial tests (bone scintigraphy, CT, pelvic MRI), 35 patients with oligometastases or without them were selected. 11 patients with multiple metastases were excluded from the study. WB-DW-MRI and choline-PET/CT was then performed on each patient within 1 week. The results were interpreted by specialists in nuclear medicine and MRI. If they were candidates for treatment with ablative SBRT (SABR), they were then evaluated every three months with both tests. Results. Choline-PET/CT detected lesions in 16 patients that were not observable using WB-DW-MRI. The results were consistent in seven patients and in three cases, a lesion was observed using WB-DW-MRI that was not detected with choline-PET/CT. The Kappa value obtained was 0.133 (p = 0.089); the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DW-MRI were estimated at 44.93, 64.29, 86.11, and 19.15%, respectively. For choline-PET/CT patients, the sensitivity, specificity, PPV, and NPV were 97.10, 58.33, 93.06, and 77.78%, respectively. Conclusions. Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT (AU)
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Assuntos
Humanos , Masculino , Neoplasias da Próstata , Tomografia por Emissão de Pósitrons , Recidiva Local de Neoplasia/complicações , Espectroscopia de Ressonância Magnética/uso terapêutico , Estudos Prospectivos , Projetos PilotoRESUMO
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