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Implication of Lymph Node Metastasis Detected on 18F-FDG PET/CT for Surgical Planning in Patients With Peripheral Intrahepatic Cholangiocarcinoma

Park, Tae Gyu MD*; Yu, Young-Dong MD; Park, Beom Jin MD, PhD; Cheon, Gi Jeong MD, PhD; Oh, Sun Young MD*; Kim, Dong-Sik MD, PhD; Choe, Jae-Gol MD, PhD*

doi: 10.1097/RLU.0b013e3182867b99
Original Articles

Objectives Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma. ICC can be divided into 2 types according to their location: peripheral and hilar types. Intense 18F-FDG uptake on PET was reported in peripheral ICC. However, the usefulness of PET/CT in detecting tumors and predicting prognosis in peripheral ICC has not been fully evaluated. In this study, we evaluated the clinical role of 18F-FDG PET/CT to predict the recurrence after the curative resection in patients with surgically indicated peripheral ICC.

Methods Eighteen patients with ICC underwent preoperative CT and 18F-FDG PET/CT scans. SUVmax of tumor, tumor to normal liver SUV ratio (TNR), lymph node status evaluated by 18F-FDG PET/CT, tumor and lymph node size measured by CT, vascular invasion confirmed by pathology, and satellite nodules found on CT were compared between 1-year recurrence group and recurrence-free group by chi-square test.

Results Of total 23 measurable lymph nodes, 4 nodes were positive and other 19 nodes were negative or equivocal on CT. Among those 23 nodes, 9 nodes were positive and other 14 nodes were negative on 18F-FDG PET/CT. The sensitivity and specificity of CT were 20.0% and 86.4%, and those of 18F-FDG PET/CT were 80.0% and 92.3%. In the comparison between 1-year recurrent and nonrecurrent groups, lymph node metastasis detected on 18F-FDG PET/CT had statistically positive correlation with the 1-year recurrence after surgical resection (P = 0.02). Other factors showed no statistically significant difference between the groups.

Conclusion We found that lymph node metastasis detected on 18F-FDG PET/CT correlated positively with 1-year recurrence after surgical resection in patients with peripheral ICC.

From the *Departments of Nuclear Medicine, †Surgery and ‡Radiology, Korea University Medical Center, Korea University College of Medicine, Seoul; and §Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.

Received for publication July 19, 2012; and revision accepted December 17, 2012.

Conflicts of interest and sources of funding: none declared.

T.G.P. and Y.-D.Y. contributed equally to this work.

Reprints: Gi Jeong Cheon, MD, PhD, Department of Nuclear Medicine, Korean University Medical Center, Seoul 136-705, Korea. E-mail:

© 2014 by Lippincott Williams & Wilkins