Introduction: Diagnosis of extraluminal recurrent rectal cancer may be difficult. Currently the diagnosis is based on routine imaging procedures. Diagnosis often remains unverified until histological proof can be acquired by transcutaneous biopsy or operative exploration. The diagnostic value of positron emission tomography (PET) in recurrent rectal cancer was evaluated in a prospective study at the Department of Surgery of the RWTH Aachen University Hospital. The aim of the study was to assess the sensitivity of PET in the detection of recurrent rectal cancer in comparison with conventional procedures. Furthermore, the valency of PET in the diagnosis of the local expansion and metastasis was evaluated.
Methods: Since June 1997, PET has been performed in all patients with suspected recurrent rectal cancer. The examined area reaches from the neck to the symphysis. Visual assessment follows transversal, frontal and sagittal sector scans. Enhanced focal FDG uptake over the physiological enrichment of the environment (e.g., urinary tract) was defined as a criterion of malignancy. The findings were compared with the results of routine diagnosis and histological examinations.
Results: Up to now, 23 patients have been subjected to a PET examination. In 17 cases, a local recurrence could be proved. An intrahepatic metastasis was found in 11 patients, pulmonary metastasis in 3 patients, lymph-node metastasis in 5 patients, and a peritoneal carcinomatosis was found in 4 patients. All these findings were confirmed by histological examinations after biopsy and operation or by other imaging procedures and the clinical follow-up.
Conclusions: The controlled results show that PET can detect recurrent rectal cancer and its metastasis with great precision. PET seems to be a useful additional examination in the diagnosis of extraluminal recurrent rectal cancer.