Invited Critique
May 1999

Invited Critique: Whole-Body PET Imaging With [18F]Fluorodeoxyglucose in Management of Recurrent Colorectal Cancer

Arch Surg. 1999;134(5):511-513. doi:10.1001/archsurg.134.5.511

Valk et al are certainly to be congratulated for their fervent enthusiasm for this new privately held technology. The skeptic might assume that since these private physicians are based in a PET imaging center, they would bias a study by design to favor PET scan; however, it is important to put aside all such potentially cynical prejudices in favor of academic interpretation of a large number of patients carefully assessed by a variety of means and numerous statistical tests. It is particularly important to do so in light of the scope of this problem. Colorectal cancer is the second most common noncutaneous malignant neoplasm, anticipated to affect approximately 165,000 people this year.1 It can also be anticipated that more than 40% of patients, despite seemingly curative resections, will experience a recurrence of their disease.24 The most common sites of recurrence are the pelvis, liver, and lungs. Over the past several decades, numerous new technologies have been introduced in an attempt to better identify and therefore more appropriately treat patients with recurrences in each of these areas. The primary tool for both preoperative and postoperative evaluation of patients with rectal carcinoma is rectal ultrasonography.57 The potential problem with rectal ultrasound is that whether the focal length is 5.0, 7.0, 7.5, or 10.0 MHz, the best clarity is in the layers of the rectal wall as opposed to within the pelvis itself. Local recurrences tend to occur not at the suture line or anastomosis but actually in the pelvis.8 Therefore, any intraluminal evidence of tumor tends to show the tip of the iceberg rather than the major nidus of tumor.