Research published in Health Technology Assessment has found little evidence to support the use of PET-CT add-on imaging device in the pre-operative staging of bowel cancer.
Worldwide, large bowel colorectal cancer accounts for more than one million cancers per year. In the UK, bowel cancer is the third commonest malignancy behind lung and breast cancer.
Several diagnostic tests are used to assess the extent of a cancer; ultrasound, magnetic resonance imaging (MRI), computerised tomography (CT) and contrast enhanced computerised tomography (CT) scanning of the chest abdomen and pelvis as well as a full blood count and biochemical profile. These can all inform the prognosis prior to surgical resection. The presence of disease distant to the site of planned surgery impacts upon type and timing of treatments. Together, this wide variation in presentations and extents of treatments underpin the rationale for accurate pre-operative staging.
The research is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme and led by Professor David Weller of the University of Edinburgh. The researchers reviewed existing evidence on the diagnostic accuracy and therapeutic impact of an add on of CT in combination with Positron Emission Tomography -- Computed Tomography (FDG PET-CT) scanning. Integrated FDG PET-CT equipment is the latest imaging technology to be used for the pre-operative staging of colorectal cancer.
The team found limited evidence to support the use of FDG PET-CT in the pre-operative staging of primary, recurrent and spreading of colorectal cancer. Although FDG PET-CT was shown to change patient management the data was divergent and the quality of research studied was generally poor. Studies reported inconsistent findings about the effect FDG PET-CT had on surgical management. In addition, it was found that the published research evaluating FDG PET-CT for primary and recurrent bowel colorectal cancer did not reflect routine UK clinical practice at this time.
However, the research did show that FDG PET-CT as an add-on imaging device is cost-effective in the pre-operative staging of recurrent colon, recurrent rectal and metastatic disease, but it was not cost -effective for primary colon or primary rectal cancers.
Professor Weller commented: "There is uncertainty about the value of using FDG PET-CT in the treatment of bowel colorectal cancer. Importantly, practitioners who access this imaging technology need to routinely collect data to enable audits of patient outcomes, including detection rate and any changes in management resulting from its use."
- J Brush, K Boyd, F Chappell, F Crawford, M Dozier, E Fenwick, J Glanville, H McIntosh, A Renehan, D Weller, M Dunlop. The value of FDG positron emission tomography/ computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation. Health Technology Assessment, 2011; 15 (35) DOI: 10.3310/hta15350
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