Diagnostic performance of positron emission tomography in the staging of pseudomyxoma peritonei

Flood, MP; Kong, JC; Pham, T; Waters, PS; Soucisse, M; Ramsay, R; Wong, HL; Mitchell, C; Michael, M; McCormick, JJ; Warrier, SK; Akhurst, T; Heriot, AG

Author(s): Flood, MP; Kong, JC; Pham, T; Waters, PS; Soucisse, M; Ramsay, R; Wong, HL; Mitchell, C; Michael, M; McCormick, JJ; Warrier, SK; Akhurst, T; Heriot, AG;
Details: Publication Year 2022-07,Volume 48,Issue #7,Page 1606-1613
Journal Title: European Journal of Surgical Oncology
Publication Type: Research article
Abstract: BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare clinical entity, commonly derived from a mucin-producing tumour of the appendix. International consensus is unclear on the role of positron emission tomography (PET) in preoperative staging. This study aimed to assess the ability of preoperative PET in predicting the histological grade of PMP. METHODS: All patients scheduled for cytoreductive surgery (CRS) +/- hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP who underwent preoperative PET at a single centre between June 2007 and June 2020 were included. A nuclear medicine physician, blinded to patient outcomes, retrospectively reviewed imaging studies to assess for maximum tumour standardised uptake value (SUV) to mean liver SUV ratio (SUV(TLR)) and maximum porta hepatis SUV to mean liver SUV ratio (SUV(PLR)). RESULTS: Between April 2007 and December 2020, a total of 204 patients underwent surgical intervention for PMP. Of these, 124 (60.8%) met the inclusion criteria. Median peritoneal carcinomatosis index for the entire cohort was 9 and complete cytoreduction (CC0/1) was achieved in 109 (88%) patients. Patients with high-grade PMP were more likely to have diffuse peritoneal disease (p < 0.001) and higher SUV(TLR) (p<0.001). The area under the ROC curve (AUC) of SUV(TLR) in predicting high-grade pathology was 71% (p = 0.003). Patients with a SUV(TLR) </= 0.78 had improved disease-free survival (p = 0.042). CONCLUSION: Preoperative PET showed positive correlation with high-grade PMP and acceptable sensitivity and specificity as a diagnostic tool. PET should be considered a useful adjunct to standard imaging for predicting histological grade in the staging of patients with PMP.
Keywords: *Appendiceal Neoplasms/pathology; Combined Modality Therapy; Cytoreduction Surgical Procedures; Humans; *Hyperthermia, Induced; *Peritoneal Neoplasms/diagnostic imaging/pathology/therapy; Positron-Emission Tomography; *Pseudomyxoma Peritonei/diagnostic imaging/pathology/therapy; Retrospective Studies; Positron emission tomography; Preoperative staging; Prognosis; Pseudomyxoma peritonei
Department(s): Surgical Oncology; Laboratory Research; Medical Oncology; Pathology; Cancer Imaging
PubMed ID: 35148916
Publisher's Version: https://doi.org/10.1016/j.ejso.2022.02.003
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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