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Comment & Response |

PET Screening for Metastatic Colorectal Adenocarcinoma

Michael S. Hofman, MBBS, FRACP1; Robert E. Ware, MBBS, FCP1; Benjamin N. Thomson, MBBS, FRACS2
[+] Author Affiliations
1Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
2Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
JAMA. 2014;312(12):1255-1256. doi:10.1001/jama.2014.9850.
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To the Editor We dispute the conclusion that fluorodeoxyglucose (FDG) PET-CT is of questionable value to patients with hepatic metastases from colorectal cancer being evaluated for curative intent surgery.1 When current best surgical practice infrequently leads to cure and has associated morbidity and cost, is a 9% improvement in surgical management of questionable value to patients?

High-level evidence indicates that FDG PET is significantly more sensitive than CT for this indication.2 The study by Dr Moulton and colleagues1 appears flawed by performing PET after chemotherapy because metabolic activity diminishes as a marker of therapeutic response. Reflecting this, when PET and CT were discordant, more patients had negative (62/263) than positive (49/263) PET scans in this study. Performing PET after chemotherapy reduces the capacity of PET to provide surgeons with a true reflection of metastatic disease.

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September 24, 2014
Carol-Anne Moulton, MB, BS; Karen Gulenchyn, MD; Mark N. Levine, MD
1University Health Network, Toronto, Ontario
2McMaster University, Hamilton Health Sciences, Hamilton, Ontario
JAMA. 2014;312(12):1256-1257. doi:10.1001/jama.2014.9853.
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