Available online at www.sciencedirect.

com

ScienceDirect
EJSO xx (2017) 1e7 www.ejso.com

Incidental detection of colorectal lesions by FDG PET/CT

scans in melanoma patients
Christopher J. Young a,b,*, Assad Zahid a, Ian Choy a,
John F. Thompson b,c, Robyn P.M. Saw b,c
a
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
b
Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
c
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
Accepted 7 September 2017
Available online - - -

Abstract
Background: Increased use of PET/CT scans in oncology patients has raised detection of Colorectal incidentalomas (CIs). The frequency
and diagnostic outcomes of identifying these lesions in melanoma patients have not previously been studied. This studies primary objective
was to determine the prevalence of CIs found on PET/CT scans in melanoma patients. The secondary objectives were to correlate the PET/
CT findings with the pathology found at colonoscopy, and identify which patients were referred for colonoscopy.
Methods: A retrospective analysis of patients identified from the prospectively collected research database of Melanoma Institute Australia.
2509 patients with melanoma underwent PET/CT scans between 2001 and 2013. The prevalence of CIs, the correlation of lesions, and the
survival of patients who underwent colonoscopy versus patients who did not were analyzed.
Results: The prevalence of CIs in melanoma patients who had PET/CT scans was 3.2%. Forty-five of the 81 (56%) patients with CIs un-
derwent colonoscopy. Of these, premalignant or malignant disease was found in 58%. Patients with previous metastatic melanoma were
significantly less likely to be referred for colonoscopy. Patients undergoing colonoscopy had significantly better survival, as did those
without previous distant metastases before the CIs were found, and those without any metastases at the time the CIs were found. These
factors were not significant on multivariate analysis.
Conclusion: The prevalence of incidental colorectal lesions identified on PET/CT scans in melanoma patients was found to be equivalent to
that in the general cancer population. Patients undergoing colonoscopy had better survival than those who did not.
Ó 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Keywords: Melanoma; FDG-PET; Colorectal lesions; Incidental; Surveillance

Introduction (PET) and low dose Computed Tomography (CT) PET/CT

Melanoma is an aggressive malignancy with the poten-
tial for metastasis to any organ system. While there is no
role for routine imaging studies in patients with AJCC stage
I and II disease, patients with stage III disease (clinically
positive lymph nodes or a pathologically positive sentinel
lymph node (SLN)), often undergo extensive imaging
studies [1].
With high rates of sensitivity and specificity, an [18F]
Fluorodeoxyglucose (FDG) Positron Emission Tomography
* Corresponding author. RPAH Medical Centre, Suite 415, 100 Carillon
Avenue, Newtown NSW 2042, Australia.
E-mail address: cyoungnsw@aol.com (C.J. Young).
scan is often used in the assessment and staging of many
types of cancer [2,3]. PET/CT imaging has also been shown
to be useful in cancer surveillance for the detection of
recurrent or metastatic disease [4e6]. Colorectal incidenta-
lomas (CIs) are unexpected colorectal findings detected on
imaging studies performed for other reasons [7]. The
increased use of PET/CT scans in oncology patients has
led to a corresponding increase in the number of CIs iden-
tified [7,8]. Incidental FDG uptake on these PET/CT scans
has been reported as nodular-focal, nodular-multifocal,
segmental, or diffuse [9]. While segmental and diffuse up-
take patterns have been shown to be associated with a low
risk of malignancy, focal and multifocal nodular patterns

http://dx.doi.org/10.1016/j.ejso.2017.09.012
0748-7983/Ó 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
2 C.J. Young et al. / EJSO xx (2017) 1e7
have been associated with actual lesions, either benign, pre-
malignant, or malignant [9].
Previous studies have examined the occurrence of
benign and malignant CIs in cancer patients undergoing
PET/CT scans [7], however the optimal management of
these patients remains unclear. Of the cancer patients
with findings suggesting a second primary malignancy,
less than 50% had a further evaluation for various reasons
including low clinical suspicion, lack of patient follow-up
or advanced primary malignancy [10,11]. However, it has
been proposed that even though PET/CT is associated
with a high false positivity rate, patients with positive re-
sults should be investigated [12e14]. In fact, multiple
studies have found that 71e86% of CIs were associated
with abnormalities found on colonoscopy [15e18] While
many of these reports discuss the issues regarding follow-
up and clinical decision making when CIs are found
[5,6,14], few of them provided management strategies for
incidental PET lesions found on PET/CT scans [13].
One limitation of these previous studies is that their find-
ings were based on a broad range of oncology patients who
underwent PET/CT scans. Moreover, there is no common
consensus as to what the best management practices should
be when CIs are detected on PET/CT scans for melanoma
patients [14]. Given that melanoma patients present unique
challenges in staging and management, a specific study of
incidental PET/CT colorectal lesions in this patient popula-
tion was undertaken.
To guide optimal management of melanoma patients
with incidental PET lesions, this study sought to determine
the frequency of incidental colorectal lesions found on
PET/CT scans in melanoma patients, to identify which pa-
tients were referred for colonoscopy, and to identify which
factors, including age, gender and the presence or not of
metastatic disease influenced referrals.
Further objectives of this study were to provide a
descriptive account of the current management of mela-
noma patients with CIs and to compare the survival of pa-
tients who underwent colonoscopy with patients who did
not.
Patients and methods
Patient population
A total of 2509 patients with melanoma who underwent
a PET/CT scan from 2001 to 2013 were identified from the
Melanoma Institute Australia (MIA) database. This mela-
noma research database is the largest global melanoma
database. Patients who had CIs on their PET/CT were
then identified and their clinical records examined in
further detail. Information extracted from the database
and patient hospital records included what, if any, follow-
up was undertaken, whether or not a colonoscopy was per-
formed, the results of the colonoscopy, and follow-up after
Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
colonoscopy. This study was approved by the MIA research
review board.
All PET/CT scans were performed at nationally ac-
credited diagnostic radiology centers. Incidental colorectal
lesions were defined, as in previous studies, as 1) FDG-avid
lesions identified in a location that would not be an ex-
pected endpoint for a particular primary malignancy, 2)
persistent activity in a distant site when the primary tumor
or similar lesions had resolved or become significantly less
FDG-avid, or 3) incidental findings in sites not expected on
the basis of the reason for ordering the PET/CT [13]. Any
variations of uptake such as focal, segmental or diffuse
were reported by the radiologists and any concerns for sus-
picious lesions were reported and further investigated.
We were unable to review the patients’ previous history
of colonoscopy or fecal occult blood tests. There is a na-
tional fecal occult blood test screening program
commencing at age 50 in Australia, but not a screening co-
lonoscopy program.
Statistical analysis
Continuous data were expressed as the mean
standard
deviation (SD), or medians, as appropriate. Differences in
continuous variables were evaluated with Student’s t-test.
Categorical data were compared by the Fisher’s exact test
or Pearson’s chi-squared test, as appropriate.
Overall survival curves were constructed using the
Kaplan-Meier (K-M) method and compared by the log-
rank test. Cox’s proportional hazard regression model
with stepwise comparisons was used to analyze indepen-
dent prognostic factors. All analyses were performed in
IBM SPSS Statistics version 24.0 software package. A p-
value <0.05 was considered significant.
Results
Between 2001 and 2013, 2509 of 16,755 melanoma pa-
tients whose details were recorded in the MIA database
(15.0%) had PET/CT scans as part of their initial investiga-
tion for metastatic disease or routine surveillance of high-
risk disease. CIs were identified in 81 of the 2509 patients
(3.2%) (Fig. 1).
Of these 81 patients who were found to have a CI, 45
(56%) proceeded to undergo a colonoscopy and were in
the Colonoscopy Group (CG), while 36 (44%) were in
the non-Colonoscopy Group (NCG). The demographic
data, primary tumor characteristics at the time of initial
melanoma presentation, and details regarding evidence of
previous metastatic disease and at the time the CIs were
found is outlined in Table 1.
Of the 45 patients in the CG, the mean time to colonos-
copy after the CI had been identified on PET/CT was
42.5
46.7 days. Of the 45 patients, 8 (18%) had a malig-
nant colonic lesion. All 8 of these tumors were adenocarci-
nomas. Eighteen patients (40%) had premalignant lesions
 C.J. Young et al. / EJSO xx (2017) 1e7 3

Fig. 1. Patient analysis flowchart. PET/CT ¼ [18F] Fluorodeoxyglucose Positron emission tomography/Computed Tomography.

(adenomatous polyps), 3 (7%) had benign lesions including
diverticula and colitis, and 16 (36%) had normal
colonoscopies.
The mean age at the time of initial primary melanoma
diagnosis was 60.5 years in the CG and 58.0 years in the
NCG (p ¼ 0.904). The mean age at the time of identifica-
tion of the CI was 63.8 years in the CG and 62.2 years in
the NCG (p ¼ 0.888). The mean time from the initial diag-
nosis of melanoma to the time of diagnosis of a CI by PET/
CT scan for all 81 patients was 4.4 years, while the average
time to diagnosis of a CI was 3.0 years in the CG and 3.7
years in the non-colonoscopy group (p ¼ 0.186).
There was no significant relationship between gender
and colonoscopy group, with 8 (18%) women in the CG
and 9 (25%) women in the NCG (p ¼ 0.584).
When comparing the presence of metastatic disease, as
identified on PET/CT scans, 23 (51%) of patients in the
CG had evidence of distant metastatic disease found at
the time of the CI, and 25 (69%) of patients in the NCG
(p ¼ 0.115). Similarly, we found that in the CG, 32
(71%) of patients had evidence of any metastatic disease
(regional, in transit or distant), compared with 28 (78%)
in the NCG (p ¼ 0.612).
With the absence of information regarding why patients
were referred for colonoscopy, the presence of metastatic
disease in PET/CT scans performed before the discovery
of the CI did shed some light on the clinical pathway of
melanoma patients. In the CG, 7 (16%) had evidence of
previous distant metastatic disease, while in the NCG, 20
(56%) had evidence of previous distant metastatic disease
(p < 0.001). Similarly, we found that in the CG, 13
(29%) of patients had evidence of any previous metastatic
disease (regional, in transit or distant), compared with 28
(78%) in the NCG (p < 0.001).
Survival curves were calculated for CG and NCG pa-
tients (Fig. 2). Overall, the 81 patients had a median sur-
vival of 20.0 months and a mean survival of 31.5
3.8
months. The mean survival time for patients in the CG
was 38.0
5.6 months and for patients in the NCG was
23.47
4.1 months (p ¼ 0.026) Univariate analysis also re-
vealed a significant effect on survival for the presence of
any metastases (in transit, nodal or distant) at the time
the CI was found, and if there had been any previous distant
metastases found. While these differences were significant
on univariate analysis, the effects were not significant on
multivariate analysis (Table 2).

Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
4 C.J. Young et al. / EJSO xx (2017) 1e7

Table 1
Clinicopathological factors for Colonoscopy Group (CG) and non-Colonoscopy Group (NCG) patients who had Colorectal incidentalomas (CIs) found on
PET/CT.
CG (n ¼ 45) NCG (n ¼ 36) P value between groups
Demographic data
Gender (male/female) 8/37 9/27 0.584
Age (years) at primary melanoma (PM) diagnosis 60.5
15.4 58.1
15.3 0.472
Age (years) at time of CIs found on PET/CT 63.8
13.7 62.2
14.4 0.609
Time (years) between PM diagnosis and CIs 3.0
4.6 3.7
6.6 0.591
Primary melanoma data
Location of tumor
Occult 5 (11%) 6 (17%) c2 [6] ¼ 6.2, p ¼ 0.406
Head 5 (11%) 7 (19%)
Neck 2 (3%) 4 (4%)
Thorax 14 (31%) 7 (19%)
Abdomen 2 (4%) 2 (6%)
Upper extremity 8 (18%) 2 (6%)
Lower extremity 9 (20%) 8 (22%)
2009 AJCC Stage
I 8 (18%) 10 (28%) c2 [3] ¼ 1.2, p ¼ 0.756
II 18 (40%) 13 (36%)
III 15 (33%) 10 (28%)
IV 4 (9%) 3 (8%)
Clark Level
1 0 (0%) 1 (3%) c2 [4] ¼ 4.8, p ¼ 0.310
2 1 (2%) 1 (3%)
3 5 (11%) 7 (19%)
4 24 (53%) 11 (31%)
5 9 (20%) 4 (11%)
Unknown 6 (13%) 12 (33%)
Average thickness (mm) 4.2
4.0 3.2
3.2 0.274
Ulceration (Yes/No) 13/32 10/26 1.0, FET
Mitosis/mm2 7.7
6.6 5.7
4.4 0.200
Metastatic disease (MD) data
Distant MD at time CIs found (Yes/No) 23/22 25/11 0.115, FET
Intransit/nodal/distant MD at time CIs found (Yes/No) 32/13 28/8 0.612, FET
Previous distant MD before CIs found (Yes/No) 7/38 20/16 <0.001, FET
Previous intransit/nodal/distant MD before CIs found (Yes/No) 13/32 28/8 <0.001, FET
FET (Fisher’s exact tests).

Discussion Kei 2010 [16] reported an average time between PET/CT

In this study the prevalence of CIs detected on PET/CT
scans performed in melanoma patients was 3.2%. This is
similar to the prevalence of CIs in a meta-analysis by Tre-
glia [7] of 32 studies (totaling 89,061 patients) which found
the pooled prevalence of CIs detected on PET/CT scans
was 3.6% for all cancer types. While none of the studies
identified in a literature review looked at melanoma pa-
tients specifically, our results suggest that the prevalence
of CIs detected on PET/CT scans for melanoma patients
is similar to the broader population of oncology patients.
Of the 81 melanoma patients who were found to have a
CI, 56% (45 patients) underwent colonoscopic assessment.
The risk of premalignant or malignant disease in our study
was 58%, which is slightly less than the pooled risk of 68%
for malignant or pre-malignant CIs calculated in Treglia’s
[7] meta-analysis.
On average, patients underwent a colonoscopy 43 days
after a CI was detected on a PET/CT scan. While very
few studies, including the meta-analysis, looked at this,
and follow up colonoscopy of 1.3 months (41 days). Docu-
menting the time for patients to undergo follow up colonos-
copy can help establish standards for patient care.
While the difference in the presence of in transit, nodal
or distant metastatic disease in the CG, when compared
with the NCG group was not statistically significant, there
was a significantly worse overall survival for patients with
such metastases. Patients with previous melanoma metasta-
ses were significantly less likely to be referred for colonos-
copy, and those with previous distant metastases had a
worse survival.
The survival analysis found that patients who under-
went colonoscopy after a CI was found on PET/CT had
a longer survival than patients who did not undergo a co-
lonoscopy. However, there may be no causal link between
colonoscopies and survival. Indeed, the analysis suggests
that patients who did not undergo a colonoscopy may
have had significantly more advanced melanoma disease
burden, so that further investigation of CI was considered
inappropriate.

Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
 C.J. Young et al. / EJSO xx (2017) 1e7 5

Fig. 2. The comparison of survival for melanoma patients with incidental colorectal lesions found on FDG PET/CT scan, 45 patients in the Colonoscopy
Group (CG) and 36 patients in the non-Colonoscopy Group (NCG).

While we were unable to determine from our data the
exact reasons why patients were or were not referred for
further investigation of their CI, our results suggest that
the prior presence of metastatic disease impacts whether
or not physicians choose to investigate CIs.
There was a statistically significant difference regarding
metastatic burden between the CG and NCG at the time of
CI diagnosis. This may have influenced the need for further
investigation due to multiple foci of disease. On reviewing
the PET scan reports, it was noted that in the colonoscopy
group, all but one patient were reported to have a focally
avid lesion in the colon while one was reported as diffuse.
In the non-colonoscopy group, patients were noted to have
more disease burden elsewhere, however the reports of the
colonic avid lesions were less defined, and some lesions re-
ported as diffuse and hence non-specific. This may have
also impacted on referral for colonoscopy. There are
many patient and disease factors with melanoma patients
that mitigate the focus or not on other disease entities.
But in general, we recommend that patients with metastatic
melanoma should continue to receive colonoscopies like for
the general population if the patient and diseases factors do
not preclude it.
Many previous studies have discussed the role of the
treating specialist’s clinical judgment in deciding whether
to investigate a CI found on a PET/CT scan and two points
of view are apparent. On the one hand, Agress et al. [6]
found that the referring physician was also focused on the
primary disease and that often follow-up of the incidental
PET finding was a relatively low priority. Wang et al.
[11] and Beatty et al. [13] also found that follow-up evalu-
ation was not recommended except when confirmation of
malignancy would significantly alter curative potential.
Evens-Sapir et al. [5] declared that there was a direct asso-
ciation between the incentive of the referring physician to
evaluate a focal lesion and the decision of whether to treat
the lesion if it was found to be malignant. These authors
suggested that evaluation of CIs is not necessarily a high
priority in the presence of metastatic disease. From this
perspective, one possible interpretation of our data would

Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
6 C.J. Young et al. / EJSO xx (2017) 1e7

Table 2
Survival analysis of prognostic factors by cox hazard model.
Univariate analysis P value Multivariate analysis P value
Odds ratio (95% CI) Odds ratio (95% CI)
Colonoscopy Group (Yes/No) 2.485 (1.117e5.531) 0.026 1.947 (0.812e4.670) 0.135
Gender (female/male) 1.330 (0.458e3.863) 0.600
Age at PM diagnosis (60/>60) 1.832 (0.828e4.054) 0.135
Age at CI find (64/>64) 1.848 (0.853e4.006) 0.120
Location of PM 0.838 (0.697e1.008) 0.061
2009 AJCC Stage of PM 1.341 (0.826e2.178) 0.235
Clark Level of PM 0.775 (0.447e1.342) 0.362
Ulceration of PM (Yes/No) 0.741 (0.341e1.613) 0.451
Distant MD at time CIs found (Yes/No) 0.566 (0.240e1.337) 0.194
IND MD at time CIs found (Yes/No) 0.286 (0.86e0.948) 0.041 0.337 (0.100e1.137) 0.080
Previous distant MD before CIs found (Yes/No) 0.420 (0.199e0.886) 0.023 0.639 (0.279e1.462) 0.289
Previous IND MD before CIs found (Yes/No) 0.435 (0.184e1.025) 0.057
PM ¼ primary melanoma, CI ¼ colorectal incidentaloma, MD ¼ Metastatic disease, IND¼Intransit/nodal/distant.

be that very few patients had colon cancer, and that follow-
up with colonoscopy may not be necessary.
However, alternatively, Pandit et al. [4] proposed that
because of the high incidence of premalignant and malig-
nant conditions identified as CIs, further diagnostic workup
was indicated. Kamel et al. [15] found that early detection
of a second primary tumor did improve the overall survival
outcome of patients and that colonoscopy was indicated.
The results of Lee et al. [14] support the need for colono-
scopic verification, while also emphasizing that cost,
procedure-related complications and clinical status, patient
performance and the likely additional benefit of further
management should all be considered by the referring
physician before further screening. These authors suggested
that follow-up evaluation of CIs is indicated because of the
high incidence of premalignant and malignant conditions in
this population.
In melanoma patients, the issue of co-existing metastatic
disease is particularly relevant given their extremely poor
prognosis. As the first group of studies indicated, a colonos-
copy would not be likely to benefit and could harm patients
with advanced metastatic disease. However, given the high
rates of identifying malignant and premalignant lesions (com-
bined 58%) in melanoma patients in this study, we suggest
that colonoscopy is indicated in most cases. In spite of the
aggressive nature of melanoma, our survival analysis demon-
strated that these patients could have a reasonable survival.
A major limitation of this retrospective study of prospec-
tively collected data was the presence of incomplete data
for some patients, while other aspects of patient care
were not documented. Furthermore, the database did not
capture the specific reasons why clinicians and patients
chose not to follow with a colonoscopy when a CI was
found. Our study population was also too small to perform
a specific sub-group analysis on those melanoma patients
with metastatic disease. Future research will be useful to
determine if there are certain sub-groups of melanoma pa-
tients for whom colonoscopy may not be indicated. A
matched cohort of patients with similar disease burden
who underwent colonoscopy or did not undergo colonos-
copy might be useful, though this may not be possible
with the limited cohort numbers.
Melanoma can, in many cases, be an aggressive malig-
nancy. Routine PET/CT imaging during the management
of the disease has led to an increase of CI findings in these
patients. Some authors have suggested that colonoscopy is
associated with an unnecessary risk and little or no benefit.
However, given the rates of incidental malignant and prema-
lignant lesions, we propose that colonoscopy is indicated in
patients with suspicious lesions. Our results suggest that if
CIs are identified in PET/CTs scans of patients with mela-
noma, a colonoscopy may have an impact on their survival.
Conflicts of interest
We have no commercial interests and no sources of sup-
port to declare.
Acknowledgements
No grant support needs to be declared.
References
[1] Stodell M, Thompson JF, Emmet L, Uren RF, Kapoor R, Saw RPM.
Melanoma patient imaging in the era of effective systemic therapies.
Eur J Surg Oncol 2017;43:1517e27.
[2] Zhuang H, Hickeson M, Chacko TK, Duarte PS, Nakhoda KZ,
Feng Q, et al. Incidental detection of colon cancer by FDG positron
emission tomography in patients examined for pulmonary nodules.
Clin Nucl Med 2002;27:628e32.
[3] Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of
incidental findings detected on FDG-PET scintigraphy. Semin Nucl
Med 2010;40:294e315.
[4] Pandit-Taskar N, Schoder H, Gonen M, Larson SM, Yeung HW.
Clinical significance of unexplained abnormal focal FDG uptake in
the abdomen during whole-body PET. Am J Roentgenol 2004;183:
1143e7.

Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
 C.J. Young et al. / EJSO xx (2017) 1e7
[5] Even-Sapir E, Lerman H, Gutman M, Lievshitz G, Zuriel L,
Polliack A, et al. The presentation of malignant tumours and pre-ma-
lignant lesions incidentally found on PET-CT. Eur J Nucl Med Mol
Imaging 2006;33:541e52.
[6] Agress H, Cooper BZ. Detection of clinically unexpected malignant
and premalignant tumors with whole-body FDG PET: histopathologic
comparison. Radiology 2004;230:417e22.
[7] Treglia G, Taralli S, Salsano M, Muoio B, Sadeghi B, Giovanella L.
Prevalence and malignancy risk of focal colorectal incidental uptake
detected by (18)F-FDG-PET or PET/CT: a meta-analysis. Radiol On-
col 2014;48:99e104.
[8] Wang X, Koch S. Positron emission tomography/computed tomogra-
phy potential pitfalls and artifacts. Curr Probl Diagn Radiol 2009;38:
156e69.
[9] Tatlidil R, Jadvar H, Bading JR, Conti PS. Incidental colonic fluoro-
deoxyglucose uptake: correlation with colonoscopic and histopatho-
logic findings. Radiology 2002;224:783e7.
[10] Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T,
et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-
2-deoxy-D-glucose positron emission tomography and computed to-
mography (FDG-PET/CT) for tumor staging in solid tumors: compar-
ison with CT and PET. J Clin Oncol 2004;22:4357e68.
[11] Wang G, Lau EW, Shakher R, Rischin D, Ware RE, Hong E, et al. How
do oncologists deal with incidental abnormalities on whole-body fluo-
rine-18 fluorodeoxyglucose PET/CT? Cancer 2007;109:117e24.
Please cite this article in press as: Young CJ, et al., Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients, Eur J Surg
Oncol (2017), http://dx.doi.org/10.1016/j.ejso.2017.09.012
7
[12] Weston BR, Iyer RB, Qiao W, Lee JH, Bresalier RS, Ross WA. Abil-
ity of integrated positron emission and computed tomography to
detect significant colonic pathology. Cancer 2010;116:1454e61.
[13] Beatty JS, Williams HT, Aldridge BA, Hughes MP, Vasudeva VS,
Gucwa AL, et al. Incidental PET/CT findings in the cancer patient:
how should they be managed? Surgery 2009;146:274e81.
[14] Lee C, Koh SJ, Kim JW, Lee KL, Im JP, Kim SG, et al. Incidental
colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy
for patients with focal uptake confined to the left-sided colon? Dig
Dis Sci 2013;58:229e35.
[15] Kamel EM, Thumshirn M, Truninger K, Schiesser M, Fried M,
Padberg B, et al. Significance of incidental 18F-FDG accumulations
in the gastrointestinal tract in PET/CT: correlation with endoscopic
and histopathologic results. J Nucl Med 2004;45:1804e10.
[16] Kei PL, Vikram R, Yeung HW, Stroehlein JR, Macapinlac HA. Inci-
dental finding of focal FDG uptake in the bowel during PET/CT: CT
features and correlation with histopathologic results. Am J Roent-
genol 2010;194:W401e6.
[17] Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F,
et al. Incidental colonic focal lesions detected by FDG PET/CT. Am J
Roentgenol 2005;185:495e500.
[18] Israel O, Yefremov N, Bar-Shalom R, Kagana O, Frenkel A,
Keider Z, et al. PET/CT detection of unexpected gastrointestinal
foci of 18F-FDG uptake: incidence, localization patterns, and clinical
significance. J Nucl Med 2005;46:758e62.