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

Eur J Surg Oncol. 2010 Mar;36(3):315-23. doi: 10.1016/j.ejso.2009.09.001. Epub 2009 Oct 8.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Laparotomy / methods*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Peritoneal Neoplasms / diagnosis*
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / surgery
  • Positron-Emission Tomography / methods*
  • Preoperative Care / methods*
  • Prognosis
  • Prospective Studies
  • Pseudomyxoma Peritonei / diagnostic imaging*
  • Pseudomyxoma Peritonei / pathology
  • Pseudomyxoma Peritonei / surgery
  • Radiopharmaceuticals*

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18