Does <SUP>18</SUP>F-FDG Positron Emission Tomography-Computed Tomography Have a Role in Initial Staging of Hepatocellular Carcinoma?

Abstract

Background and Aim: The utility of fluorine-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography-computed tomography (PET/CT) in initial staging of hepatocellular carcinoma (HCC) has yet to be fully explored. We assessed the usefulness of F-18-FDG PET/CT in initial staging of HCC. Methods: A total of 457 consecutive patients initially diagnosed with HCC at Seoul National University Hospital between 2006 and 2012 were evaluated retrospectively to assess the impact of F-18-FDG PET/CT on staging and compliancy with Milan criteria, relative to dynamic CT of liver and chest x-ray. Results: Seven among the 457 patients studied showed a shift in Barcelona Clinic Liver Cancer [BCLC] stage (A -> C: 6 patients; B -> C: 1 patient) and 5 patients who had originally met Milan criteria no longer qualified. F-18-FDG PET/CT had value in initial staging of early (stage A) or intermediate (stage B) HCC, as determined by dynamic CT of liver and BCLC or AJCC classifications, whereas BCLC stage 0 and stage C tumors were unchanged (P<0.001). F-18-FDG PET/CT disclosed additional metastases in patients with American Joint Committee on Cancer [AJCC] T2 (2.7%), T3a (5.3%), and T3b (4.8%) classifications. Conclusions: In initial staging of HCC, F-18-FDG PET/CT provided additional information, impacting the patients with BCLC (stages A and B) and AJCC (T2 and T3) classifications. Its use might be thus appropriate for these patient subsets, especially if hepatic resection or liver transplantation is planned.