Comparison of Conventional Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnostic Accuracy of Staging in Patients with Intrahepatic Cholangiocarcinoma

Abstract

We aimed to examine the accuracy of tumor staging of intrahepatic cholangiocarcinoma (ICC) by using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT). From January 2001 to December 2021, 202 patients underwent PET-CT, CT, and MRI for the initial staging of ICC in two institutions. Among them, 102 patients had undergone surgical treatment. Ninety patients who had a histopathological diagnosis of ICC were retrospectively reviewed. The sensitivity and specificity of 18F-FDG PET-CT, CT, and magnetic resonance imaging (MRI) in detecting tumors, satellite focus, vascular invasion, and lymph node metastases were analyzed. Ninety patients with histologically diagnosed ICC were included. PET-CT demonstrated no statistically significant advantage over CT and MR in the diagnosis of multiple tumors and macrovascular invasion, and bile duct invasion. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT in lymph node metastases were 84%, 86%, 91%, 84%, and 86%, respectively. PET-CT revealed a significantly higher accuracy compared to CT or MRI (86%, 67%, and 76%, p < 0.01, respectively) in the diagnosis of regional lymph node metastases. The accuracy of tumor staging by PET-CT was higher than that by CT/MRI (PET-CT vs. CT vs. MRI: 68/90 vs. 47/90 vs. 51/90, p < 0.05). 18F-FDG PET-CT had sensitivity and specificity values for diagnosing satellite focus and vascular and bile duct invasion similar to those of CT or MRI; however, PET-CT showed higher accuracy in diagnosing regional lymph node metastases. 18F-FDG PET-CT exhibited higher tumor staging accuracy than that of CT/MRI. Thus, 18FDG PET-CT may support tumor staging in ICC.