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Open Access Research article

Diagnostic performance of contrast enhanced CT and 18F-FDG PET/CT in suspicious recurrence of biliary tract cancer after curative resection

Yun-Gyoo Lee1, Sae-Won Han14, Do-Youn Oh14*, Eui Kyu Chie2, Jin-Young Jang3, Seock-Ah Im14, Tae-You Kim145, Sun-Whe Kim3, Sung Whan Ha2 and Yung-Jue Bang145

Author Affiliations

1 Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

2 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea

3 Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea

4 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

5 Department of Molecular Medicine & Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea

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BMC Cancer 2011, 11:188  doi:10.1186/1471-2407-11-188

Published: 21 May 2011

Abstract

Background

Because of the late clinical presentation of biliary tract cancer (BTC), only 10% of patients are eligible for curative surgery. Even among those patients who have undergone curative surgery, most patients develop recurrent cancer. This study is to determine the clinical role of 18F-FDG PET/CT during post-operative surveillance of suspected recurrent BTC based on symptoms, laboratory findings and contrast-enhanced CT (ceCT) findings.

Methods

We consecutively enrolled 50 patients with BTC who underwent curative surgery. An 18F-FDG PET/CT was obtained for assessment of recurrence based on clinical suspicion during post-operative surveillance. The final confirmation of recurrence was determined pathologically or clinically. When a pathologic confirmation was impossible or inconclusive, a clinical confirmation was used by radiologic correlation with subsequent follow-up ceCT at a minimum of 3-month intervals. Diagnostic efficacy was evaluated by comparing the results of ceCT and 18F-FDG PET/CT with the final diagnosis.

Results

Among the 50 patients, 34(68%) were confirmed to have a recurrence. PET/CT showed higher sensitivity (88% vs. 76%, p = 0.16) and accuracy (82% vs. 66%, p = 0.11) for recurrence compared to ceCT, even though the difference was not significant. The positive (86% vs. 74%, p = 0.72) and negative predictive values for recurrence (73% vs. 47%, p = 0.55) were not significantly different between PET/CT and ceCT. However, an additional PET/CT on ceCT significantly improved the sensitivity than did a ceCT alone (94% [32/34] for PET/CT on ceCT vs. 76% [26/34] for ceCT alone, p = 0.03) without increasing the specificity, positive predictive value, and negative predictive value.

Conclusions

18F-FDG PET/CT alone is not more sensitive or specific than ceCT in the detection of recurrent BTC after curative surgery. These results do not reach statistical significance, probably due to the low number of patients. However, an additional 18F-FDG PET/CT on ceCT significantly improves the sensitivity of detecting recurrences.

Keywords:
18F-FDG PET/CT; biliary tract cancer; surveillance; recurrence