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

• Published in: Korean journal of radiology Vol. 21; no. 12; pp. 1355 - 1366
• Main Authors: Kim, Nam Hee, Lee, Sung Ryol, Kim, Young Hwan, Kim, Hong Joo
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.12.2020; 대한영상의학회
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile ducts; Cancer; Cholangiocarcinoma; Cholangiocarcinoma - diagnostic imaging; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Endoscopy; Female; Fluorodeoxyglucose F18 - chemistry; Glucose; Humans; Lymphatic Metastasis; Lymphatic system; Magnetic Resonance Imaging; Male; Metastasis; Middle Aged; Nuclear Medicine; Patient assessment; Positron Emission Tomography Computed Tomography - methods; Prognosis; Proportional Hazards Models; Survival Rate; Tomography; Tomography, X-Ray Computed; Tumors; 방사선과학; Extrahepatic cholangiocarcinoma; FDG PET-CT; Survival; Maximum standardized uptake value
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2019.0891

We aimed to evaluate the diagnostic value and prognostic relevance of FDG positron emission tomography/computed tomography (PET-CT) in extrahepatic cholangiocarcinoma patients. 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. The sensitivity of FDG PET-CT for detecting primary tumor and regional lymph node metastases was lower than that of MDCT or MRI ( < 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 < 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 (SUV ) 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 SUV 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). FDG PET-CT showed lower sensitivity for detecting primary tumor and regional lymph node involvement than MDCT and MRI. However, the SUV of primary tumors and metastatic lesions derived from FDG PET-CT could have significant implications for predicting prognoses in extrahepatic cholangiocarcinoma patients.