Role of <sup>18</sup>F-FDG PET/CT for detection of recurrence and metastases in renal cell carcinoma—are we underusing PET/CT?

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Abstract

PURPOSE

The aim of this study was to compare ¹⁸F-fluorodeoxyglucose positron emission tomography–computed tomography ( ¹⁸F-FDG PET/CT) scan with computed tomography (CT) scan for detecting recurrence and metastasis in renal cell carcinoma patients.

METHODS

This retrospective study included patients from October 2013 to April 2017. Contrast-enhanced CT and PET/CT scans were compared and correlated with histopathology or/and follow-up studies.

RESULTS

Seventy-six patients, 60 males, were included. Lesions included primary renal, recurrent renal fossa lesions, lymph nodes, and distant metastatic lesions. Of 176 malignant lesions, CT detected 157 lesions; of which, 154 were true positive. Twenty-two false-negative lesions showed abnormal FDG uptake. CT scan had positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and accuracy of 98.0%, 37.1%, 87.5%, 81.2%, and 86.9%, respectively. All 176 lesions were PET/CT-positive. PET/CT had PPV, NPV, sensitivity, specificity, and accuracy of 100% each. The specificity and NPV of PET/CT were superior ( P < .05).

CONCLUSION

PET/CT appears more accurate than CT scan for detecting metastasis and recurrence in renal cell carcinoma patients.

Related collections

Most cited references 17

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The use of standardized uptake values (SUVs) is now common place in clinical 2-deoxy-2-[(18)F] fluoro-D-glucose (FDG) position emission tomography-computed tomography oncology imaging and has a specific role in assessing patient response to cancer therapy. Ideally, the use of SUVs removes variability introduced by differences in patient size and the amount of injected FDG. However, in practice there are several sources of bias and variance that are introduced in the measurement of FDG uptake in tumors and also in the conversion of the image count data to SUVs. In this article the overall imaging process is reviewed and estimates of the magnitude of errors, where known, are given. Recommendations are provided for best practices in improving SUV accuracy. Copyright © 2010 Elsevier Inc. All rights reserved.

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Significance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for the postoperative surveillance of advanced renal cell carcinoma.

Gillian Lee, Moon Ki Jo, J. Park (2009)

To evaluate the role of (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) for the surveillance of patients with renal cell carcinoma (RCC) who have a high risk of local recurrence or distant metastasis, by comparing the results with those of conventional imaging methods. Sixty-three patients with RCC had conventional imaging studies and FDG PET/CT during the follow-up after surgical treatment. Their pathological stages were T2 in 28 patients, T3a in 14, T3b in 19 and T4 in two; lymph-node or distant metastases were present in 12 patients. Suspicious recurrent or metastatic lesions were confirmed by histopathology or by clinical follow-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional surveillance methods and FDG PET/CT were analysed. The difference in the accuracy of FDG PET/CT by nuclear grade and histological subtype of tumours was also assessed. The FDG PET/CT accurately classified the presence of a recurrence or metastasis in 56 (89%) patients. FDG PET/CT had an 89.5% sensitivity, 83.3% specificity, 77.3% positive predictive value, 92.6% negative predictive value, and 85.7% accuracy in detecting recurrence or metastasis, which was not significantly different from the results with conventional methods. Moreover, the accuracy of the FDG PET/CT by nuclear grade and histological subtypes was not significantly different. For the surveillance of high-risk RCC, FDG PET/CT had results that were as good as conventional methods and were not influenced by the nuclear grades of cancer cells. In addition, it was possible to examine all organ systems in one procedure, and there was no need for contrast agents, that can damage renal function. Therefore, FDG PET/CT might replace conventional methods.

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Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma.

S Ramdave, G W Thomas, S Berlangieri … (2001)

We evaluate the accuracy of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) for staging and management of renal cell carcinoma. FDG-PET was performed in 25 patients with known or suspected primary renal tumors and/or metastatic disease and compared with conventional imaging techniques, including computerized tomography (CT). Histopathological confirmation was obtained in 18 patients and confirmation of the disease was by followup in the remainder. The impact of FDG-PET on disease management was also assessed. Of the 17 patients with known or suspected primary tumors FDG-PET was true positive in 15, true negative in 1 and false-negative in 1. Comparative CT was true positive in 16 patients and false-positive in 1. The accuracy of FDG-PET and CT was similar (94%). All patients would have undergone radical nephrectomy after conventional imaging findings but FDG-PET results altered treatment decisions for 6 (35%), of whom 3 underwent partial nephrectomy and 3 avoided surgery due to confirmation of benign pathology or detection of unsuspected metastatic disease. Of the 8 cases referred for evaluation of local recurrence and/or metastatic disease FDG-PET changed treatment decisions in 4 (50%), with disease up staged in 3 and recurrence excluded in 1. Compared with CT, FDG-PET was able to detect local recurrence and distant metastases more accurately and differentiated recurrence from radiation necrosis. FDG-PET accurately detected local disease spread and metastatic disease in patients with renal cell carcinoma and altered treatment in 40%. FDG-PET may have a role in the diagnostic evaluation of patients with renal cell carcinoma preoperatively and staging of metastatic disease.

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Author and article information

Journal

Journal ID (nlm-ta): Diagn Interv Radiol

Journal ID (iso-abbrev): Diagn Interv Radiol

Title: Diagnostic and Interventional Radiology

Publisher: Turkish Society of Radiology

ISSN (Print): 1305-3825

ISSN (Electronic): 1305-3612

Publication date Collection: September 2022

Publication date (Electronic): 01 September 2022

Volume: 28

Issue: 5

Pages: 498-502

Affiliations

[1 ]From the Department of Nuclear Medicine (M.P. , N.S.), PD Hinduja National Hospital and Medical Research Centre, Mumbai, India; and Department of Urology (C.B.P., S.N.L.S.), PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.

Author notes

You may cite this article as: Pereira M, Punatar CB, Singh N, Sagade SN. Role of ¹⁸F-FDG PET/CT for detection of recurrence and metastases in renal cell carcinoma—are we under-using PET/CT? Diagn Interv Radiol. 2022; 28(5): 498-502.

Author information

Melvika Pereira http://orcid.org/0000-0002-6730-9825

Chirag B. Punatar http://orcid.org/0000-0003-4728-017X

Natasha Singh http://orcid.org/0000-0002-3568-6829

Article

Publisher ID: dir-28-5-498

DOI: 10.5152/dir.2022.21096

PMC ID: 9682604

PubMed ID: 36218153

SO-VID: ae2f9f48-f919-48a1-bc2d-507e39e38c90

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Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.