Pseudomyxoma Peritonei : Role of 18F-FDG PET in preoperative evaluation of pathological grade and potential for complete cytoreduction

• Published in: European journal of surgical oncology 2010-03, Vol.36 (3), p.315-323
• Main Authors: Passot, G, Glehen, O, Pellet, O, Isaac, S, Tychyj, C, Mohamed, F, Giammarile, F, Gilly, F.N, Cotte, E
• Format: Article
• Language: English
• Subjects: 18F-FDG PET; Adult; Aged; Aged, 80 and over; Biopsy; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Laparotomy - methods; Male; Middle Aged; Neoplasm Staging; Peritoneal Neoplasms - diagnosis; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Positron-Emission Tomography - methods; Preoperative assessment; Preoperative Care - methods; Prognosis; Prospective Studies; Pseudomyxoma peritonei; Pseudomyxoma Peritonei - diagnostic imaging; Pseudomyxoma Peritonei - pathology; Pseudomyxoma Peritonei - surgery; Radiopharmaceuticals; Surgery
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2009.09.001

Abstract Introduction For pseudomyxoma peritonei (PMP), survival depends on pathological grade and completeness of cytoreductive surgery. The aim of the study was to assess the ability of preoperative 18F-FDG PET to determine these 2 prognosis indicators. Material and methods In this prospective single centre study, all patients presenting with PMP were included. They underwent a preoperative 18F-FDG PET with a double radiological evaluation and an explorative laparotomy with the objective of optimal cytoreduction followed by a hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC). Patients with non resectable disease underwent debulking surgery without HIPEC. The Completeness of Cytoreduction was assessed by CC score. Results Thirty-four patients were included. PET scanning was positive for 19 patients with grade II (hybrid form) or III (Peritoneal Mucinous Carcinomatosis) and for 2 patients with grade I (disseminated peritoneal adenomucinosis), and negative for 3 patients with grade II - III and for 10 patients with grade I. PET scanning was positive for 6 patients with CC score 2 - 3 and for 16 patients with CC score 0, and negative for 2 patients with CC score 2 - 3 and for 10 patients with CC score 0. The 18F-FDG PET interpretation distinguished 2 patients groups (grade I and grade II - III) with a sensitivity of 90% and a specificity of 77%. Moreover, probability of complete cytoreduction when PET was negative was over 80%. Conclusion Preoperative 18F-FDG PET may predict pathological grade and completeness of cytoreduction which are the two main prognostic factors in patients with PMP.