Korean J Radiol.  2020 Dec;21(12):1360-1371. 10.3348/kjr.2019.0891.

Diagnostic Performance and Prognostic Relevance of FDG Positron Emission Tomography/Computed Tomography for Patients with Extrahepatic Cholangiocarcinoma

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract


Objective
We aimed to evaluate the diagnostic value and prognostic relevance of FDG positron emission tomography/computed tomography (PET-CT) in extrahepatic cholangiocarcinoma patients.
Materials and Methods
This study included 234 extrahepatic cholangiocarcinoma patients who underwent FDG PET-CT between June 2008 and February 2016. The diagnostic performance of FDG PEG-CT was compared to that of contrast-enhanced multidetector row CT (MDCT) and MRI. Independent prognosticators for poor survival were also assessed.
Results
The sensitivity of FDG PET-CT for detecting primary tumor and regional lymph node metastases was lower than that of MDCT or MRI (p < 0.001), whereas the specificity and positive predictive value for detecting regional lymph nodes metastases was significantly better in FDG PET-CT compared to MDCT and MRI (all p < 0.001). There was no significant difference in the diagnostic yield of distant metastases detection among three diagnostic imaging techniques. In a multivariate analysis, maximum standardized uptake values (SUVmax) of the primary tumor (adjusted hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.13–2.69) and of the metastatic lesions ≥ 5 (adjusted HR, 8.10; 95% CI, 1.96–33.5) were independent contributors to poor overall survival in extrahepatic cholangiocarcinoma patients. In a subgroup analysis of 187 patients with periductal infiltrating type of cholangiocarcinoma, an SUVmax of the primary tumor ≥ 5 was associated with an increased risk of regional lymph node (adjusted odds ratio [OR], 1.60; 95% CI, 0.55–4.63) and distant metastases (adjusted OR, 100.57; 95% CI, 3.94– 2567.43) at diagnosis as well as with poor overall survival (adjusted HR, 1.81; 95% CI, 1.04–3.15).
Conclusion
FDG PET-CT showed lower sensitivity for detecting primary tumor and regional lymph node involvement than MDCT and MRI. However, the SUVmax of primary tumors and metastatic lesions derived from FDG PET-CT could have significant implications for predicting prognoses in extrahepatic cholangiocarcinoma patients.

Keyword

FDG PET-CT; Maximum standardized uptake value; Extrahepatic cholangiocarcinoma; Survival
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