Preoperative Diagnosis of Multiple Primary Malignant Neoplasm in Gastrointestinal and Breast Cancers:Impact of FDG-PET/CT

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SUMMARYObjective:The reports of multiple primary malignant neoplasm (MPMN) have increased due to the developmentof imaging technologies that have influenced the extension of the 5-year relative survival ratefor all cancers. Integrated positron emission and computed tomography( PET/CT) with 18F-fluorodeoxyglucose(FDG) has shown its advantages for detecting, staging, evaluating the prognosis, and offering betterinsights for survivors, their families and physicians. The aim of this study was to retrospectively investigatethe impact of whole-body FDG-PET/CT in detecting MPMN during the initial staging work-up of gastrointestinaland breast malignancy, and to describe their characteristics.Methods:The cases were identified by reviewing the Dokkyo Medical University Hospital PET Center'sdatabase, searching for patients referred from the Department of Surgical Oncology and the Department ofGastroenterological Surgery, who underwent preoperative staging with whole-body FDG PET/CT at ourcenter between January 2007 and December 2009. A total of 778 patients matched these criteria. Of them,40 PET/CT reports mentioned suspicious cases of MPMN. The medical records of these 40 cases were retrievedand examined. The follow-up data of these patients was reviewed until February 2010.Results:Of 778, 32 patients were diagnosed with additional unexpected cancers, which 27( 3.5%) wereincidental double cancers and 5( 0.64%) had triple primary lesions. Overall 37 MPMN, twelve correspondedto stage 0, nineteen to stages I−II, three to stages III−IV, and three remained uncertain. Sensitivity andpositive predictive value of FDG PET/CT in detecting a controversial lesion were 76.5% and 70.3%, respectively.The colorectum was the most common site for synchronous MPMN (17 of 37 cancers;45.9%), followedby stomach( 9;24.3%), prostate( 3;8.1%), thyroid( 3;8.1%), breast( 2;5.4%), biliary duct( 1;2.7%), kidney( 1;2.7%), and lung( 1;2.7%).Conclusions:FDG PET/CT was useful for finding multiple primary malignant neoplasm with a relativelyhigh sensitivity. Physicians should pay special attention to rule out the presence of unexpected additionalprimary lesions in initial staging work-up for colorectal cancer.

identifier:3

identifier:KJ00006978699

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