In eight patients colonoscopy was not performed and their follow-up data were not available. The primary malignancies in these patients were non-Hodgkin's lymphoma (NHL) ( n = 7), lung cancer ( n = 3), esophageal cancer ( n = 3), rectal cancer ( n = 3), cervix cancer ( n = 1), breast cancer ( n = 1), endometrial cancer ( n = 1), sarcoma ( n = 1), tongue ( n = 1), hepatoma ( n = 1), cancer of unknown primary ( n = 1), and nasopharyngeal cancer ( n = 1). Colonoscopy and pathology findings were considered as gold standard. Lesions which appeared neoplastic on colonoscopy were confirmed with histopathology obtained after biopsy or polypectomy/surgery. Twenty-four (15 men and 9 women, age range 46-80 years) out of the 32 patients underwent a colonoscopy within a month of the PET/CT study. There were 32 out of 9000 (0.35%) patients whose PET/CT reports mentioned incidental focal colonic FDG uptake with a recommendation to obtain a colonoscopic confirmation of a pre-neoplastic or neoplastic pathology. Patients imaged for metastatic staging of primary colorectal cancer whose reports showed a focus of incidental FDG uptake elsewhere in the large bowel other than the primary site were also included. ![]() Patients whose PET/CT reports read incidental focal colonic/rectal FDG uptake were considered for analysis. Our institutional review board waives the approval or individual informed consent for retrospective review of imaging studies and electronic medical records. The electronic medical records of patients who underwent FDG PET/CT at our institution for a 2½-year period from January 2009 to July 2011 were reviewed for PET/CT indication – findings, demographic data, colonoscopy results, and histopathologic correlation. ![]() The aim of our study was to assess the relevance of an incidentally detected focal FDG PET finding in the colon by comparing it with colonoscopy in the context of detecting pre-cancerous lesions and synchronous malignancies. However, almost all of them are in Western populations, which have a markedly different epidemiological profile for colorectal premalignant and malignant conditions as compared to that of the Indian subcontinent. There are studies in literature which have analyzed incidental colorectal FDG uptake. The colon is one region where incidental FDG uptake is not infrequently encountered. The clinical value of incidental tracer uptake has been studied and has been attributed to various physiological phenomena, clinically significant pathologic processes, metastatic spread, and synchronous or metachronous second malignancies. In spite of the correlative imaging capabilities of the hybrid scanner, one of the common occurrences in PET/CT acquisitions is the incidental or unexpected FDG uptake in regions which are beyond the commonly known disease patterns. The advent of integrated PET/CT has to an extent reduced the FPs due to excellent anatomical correlation available in the combined study. However, increased FDG uptake due to various physiological and inflammatory conditions in the body can lead to false-positive (FP) FDG PET results. ![]() The past few years have seen such a rapid growth of PET/CT that it is now being recommended as the initial imaging modality for staging, restaging, and treatment response assessment of several malignancies. With the introduction of combined PET/computed tomography (CT), the accuracy of the technique has improved further due to combination of anatomical and functional data in a single study. Positron emission tomography (PET) using 18F-flurodeoxyglucose (FDG) is used commonly for staging and restaging of several cancers.
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