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Invited Critique
December 1, 2006

Preoperative Positron Emission Tomography to Evaluate Potentially Resectable Hepatic Colorectal Metastases—Invited Critique

Arch Surg. 2006;141(12):1227. doi:10.1001/archsurg.141.12.1227

This article reports a single institution's experience with PET or PET-CT in patients referred for surgical treatment of hepatic metastases. During a 3-year period, 71 patients who were judged operative candidates by CDMs underwent PET. Detection of hepatic lesions was 100% by CDMs, but PET had only a 90% concordance rate, missing 7 patients' disease. False-negative findings were more likely to be at the dome of the liver or in lesions less than 3 cm in size. Positron emission tomography identified additional disease in 32% of the cases, with more than half of those (13/23) in extra-abdominal locations. The impact of PET on clinical decision making was difficult to fully evaluate. The authors report that a total of 17 patients (24%) had their management altered on the basis of PET findings, but then tack on an additional 8 patients whose PET findings were ignored or further ruled out. The total would then be 25 patients (35%) who may have had their operative decisions altered. The overall rate of false-positive PET findings is difficult to determine because of different false-positive rates depending on whether the PET findings were used in clinical decision making. In the best circumstance, there were no false-positive findings; in contrast there were 6 false-positive findings in the “ignored” group. False upstaging or downstaging rates for PET were 8% and 15%, respectively, and no statistically significant difference was found between PET and PET-CT.

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