Preoperative 18F-FDG PET/CT as a surgical triage tool for synchronous neoplasm detection in acute left-sided obstructive colorectal cancer: a two-institution retrospective cohort study - Report - MDSpire

Utilizing Preoperative 18F-FDG PET/CT for Surgical Decision-Making in Identifying Synchronous Neoplasms in Acute Left-Sided Obstructive Colorectal Cancer: A Retrospective Study Across Two Institutions

  • By

  • Kyung Uk Jung

  • Sung Ryol Lee

  • Joosung Park

  • Hyung Ook Kim

  • Hungdai Kim

  • Hee-Sung Song

  • Ji Young Lee

  • Yong Bog Kim

  • Jaemin Jo

  • Ji Eun Park

  • Hyun Joo Song

  • Heung Up Kim

  • Weon Young Chang

  • Ho-kyung Chun

  • Donghyoun Lee

  • July 20, 2026

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Clinical Report: Utilizing Preoperative 18F-FDG PET/CT in Colorectal Cancer

Overview

This study evaluates the diagnostic performance of preoperative 18F-FDG PET/CT in detecting synchronous neoplasms in patients with acute left-sided obstructive colorectal cancer. The findings indicate that PET/CT has high specificity (95.0%) but moderate sensitivity (77.8%) for invasive synchronous colorectal cancer.

Background

Synchronous colorectal cancers (sCRC) can occur in 3%-6% of colorectal cancer patients, complicating surgical decision-making in obstructive colorectal cancer (OCC). The inability to perform complete preoperative colonoscopy in these patients increases the risk of missing additional malignancies.

Data Highlights

ParameterInvasive sCRCCSN
Sensitivity77.8%52.9%
Specificity95.0%96.2%
PPV50.0%64.3%
NPV98.5%94.1%

Key Findings

  • Invasive sCRC was confirmed in 9 patients (6.0%) and CSN in 17 patients (11.4%).
  • For invasive sCRC, PET/CT demonstrated a sensitivity of 77.8% and specificity of 95.0%.
  • The negative predictive value (NPV) for invasive sCRC was 98.5%, indicating a low rate of missed cancers.
  • Among 135 PET-negative patients, only 2 (1.5%) had invasive sCRC.
  • Secondary curative resection was required in 5 patients (3.4%) and therapeutic endoscopy in 8 (5.4%).

Clinical Implications

Preoperative 18F-FDG PET/CT may assist in identifying patients who require further assessment for synchronous neoplasms.

Conclusion

The study evaluates the role of preoperative 18F-FDG PET/CT in surgical decision-making for patients with acute left-sided obstructive colorectal cancer.

Related Resources & Content

  1. Author(s)/Org, Source, Year -- Title
  2. European Radiology, 2024 -- Guidelines for Staging and Restaging in Oncology Using FDG-PET/CT
  3. Frontiers in Oncology, 2026 -- Diagnostic performance of 18F-FDG PET-CT and SPECT for bone metastases from colorectal cancer
  4. European Radiology, 2026 -- Improved detection of local tumor progression after ablation or resection of colorectal liver metastases
  5. ACR Appropriateness Criteria® Colorectal Cancer Screening: 2024 Update
  6. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
  7. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer
  8. Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography for the detection of proximal synchronous lesions in patients with obstructive colorectal cancer
  9. PET/CT Integrated With CT Colonography in Preoperative Obstructive Colorectal Cancer by Incomplete Optical Colonoscopy
  10. Diagnostic accuracy and treatment benefit of PET/CT in staging of colorectal cancer compared to conventional imaging
  11. https://coloproctol.org/upload/pdf/ac-2024-00059-0008.pdf
  12. ACR Appropriateness Criteria® Colorectal Cancer Screening: 2024 Update - PubMed
  13. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up - ScienceDirect
  14. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

Original Source(s)

Preoperative 18F-FDG PET/CT as a surgical triage tool for synchronous neoplasm detection in acute left-sided obstructive colorectal cancer: a two-institution retrospective cohort study

  • by Kyung Uk Jung, Sung Ryol Lee, Joosung Park, Hyung Ook Kim, Hungdai Kim, Hee-Sung Song, Ji Young Lee, Yong Bog Kim, Jaemin Jo, Ji Eun Park, Hyun Joo Song, Heung Up Kim, Weon Young Chang, Ho-kyung Chun, Donghyoun Lee

  • July 20, 2026

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