Is combined 18F-fluorodeoxyglucose-positron emission tomography/computed tomography superior to positron emission tomography or computed tomography alone for diagnosis, staging and restaging of pancreatic lesions?
ABSTRACT To evaluate whether combined 18F-FDG PET/CT has an additive value over 18F-FDG-PET or CT alone for diagnosis, staging and restaging of pancreatic lesions.
Forty-six consecutive patients (23 women, 23 men; median age 62.5 years) underwent FDG-PET/CT. Analysis of PET, CT and fused PET/CT images was performed by 2 readers. Patients were divided into 2 groups: diagnosis and staging of primary tumours (n=34) and restaging: screening for recurrent or progressive pancreatic cancer (n=12). Accuracy analysis was performed lesion-by-lesion and patient-by-patient. Results were correlated with histopathology or clinical follow-up.
Ninety-five foci were identified on PET, 140 lesions on CT and 119 on PET/CT. Thirty-four lesions were defined as 'definitely pathologic' and localised in pancreas, liver, lung or bone by all 3 techniques with equal certainty. In 11 patients malignancy was ruled out with the highest certainty by PET/CT. All 3 modalities made 2 false positive diagnoses of malignancy and missed metastases or vascular ingrowth in 7 patients. The accuracy rate of PET/CT (91.2%) for diagnosis of primary pancreatic lesions is higher compared to CT (88.2%) and PET alone (82.3%). Also for locoregional staging PET/CT has a higher accuracy rate (85.3%) compared to CT (83.8%) and PET (79.4%). When used for restaging, sensitivity (90.0%) and accuracy rate (91.6%) were highest for PET and PET/CT. CT had a lower sensitivity (80.0%).
Topographical assignment of 'spots' with high FDG uptake is superior with PET/CT compared to PET alone. Fused PET/CT has a slightly higher sensitivity and accuracy rate for diagnosis and locoregional staging of primary pancreatic lesions compared to CT alone. PET and PET/CT perform equally well in screening for recurrent or progressive pancreatic cancer, with high accuracy. Due to its unlimited access, lower radiation exposure and cost, multidetector row CT remains the imaging technique of choice for diagnosis, staging and screening for recurrent pancreatic cancer.
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ABSTRACT: 18F-Fluorodeoxyglucose-positron emission tomography/computerised tomography (FDG-PET/CT) was investigated for evaluation of periampullary tumours and other gastrointestinal neoplasms. The aim of this study was to evaluate the utility of FDG-PET/CT for detection of lymph node metastasis in periampullary tumours by comparing the preoperative FDG-PET/CT scan finding with postoperative histopathology of lymph nodes. Study was done on 24 patients with diagnosis of periampullary carcinoma either proven or suspected on conventional radiology. Standard uptake value (SUV) were measured for lymph node areas with uptake in FDG-PET/CT and compared with histopathological lymph node status. For detection of lymph node metastasis, FDG-PET/CT with cutoff value SUV max ≥2.0 had a sensitivity of 71.4 % and specificity of 77.8 % and that for SUV max ≥2.5 and 2.8 were 57.1, 42.9 and 77.8, 77.8 %, respectively. The sensitivity and specificity of FDG-PET/CT at each lymph node groups were 72 and 89 % in peripancreatic area, 100 and 93 % in hepatoduodenal area and 100 and 100 % in aortocaval area at SUV max ≥2.0, respectively. At SUV max ≥2.5 the values were 57 and 89 % in peripancreatic area, 100 and 93 % in hepatoduodenal area and 100 and 93 % in aortocaval area. FDG-PET-CT has a possible role in detection of lymph node metastasis in periampullary carcinomas and may be used as a guide for possible lymphadenectomy during surgery and for prognostic purpose.Updates in surgery. 03/2013;
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ABSTRACT: Pancreatic cancer is difficult to diagnose at an early stage and generally has a poor prognosis. Surgical resection is the only potentially curative treatment for pancreatic carcinoma. To improve the prognosis of this disease, it is essential to detect tumors at early stages, when they are resectable. The optimal approach to screening for early pancreatic neoplasia has not been established. The International Cancer of the Pancreas Screening Consortium has recently finalized several recommendations regarding the management of patients who are at an increased risk of familial pancreatic cancer. In addition, there have been notable advances in research on serum markers, tissue markers, gene signatures, and genomic targets of pancreatic cancer. To date, however, no biomarkers have been established in the clinical setting. Advancements in imaging modalities touch all aspects of the clinical management of pancreatic diseases, including the early detection of pancreatic masses, their characterization, and evaluations of tumor resectability. This article reviews strategies for screening high-risk groups, biomarkers, and current advances in imaging modalities for the early detection of resectable pancreatic cancer.World Journal of Gastroenterology 08/2014; 20(32):11230-11240. · 2.43 Impact Factor
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ABSTRACT: The impact of [(18)F]fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) restaging on management decisions and outcomes in patients with locally advanced pancreatic carcinoma (LAPC) scheduled for concurrent chemoradiotherapy (CRT) is examined. Seventy-one consecutive patients with conventionally staged LAPC were restaged with PET/CT before CRT, and were categorized into non-metastatic (M0) and metastatic (M1) groups. M0 patients received 50.4 Gy CRT with 5-fluorouracil followed by maintenance gemcitabine, whereas M1 patients received chemotherapy immediately or after palliative radiotherapy. In 19 patients (26.8%), PET/CT restaging showed distant metastases not detected by conventional staging. PET/CT restaging of M0 patients showed additional regional lymph nodes in 3 patients and tumors larger than CT-defined borders in 4. PET/CT therefore altered or revised initial management decisions in 26 (36.6%) patients. At median follow-up times of 11.3, 14.5, and 6.2 months for the entire cohort and the M0 and M1 cohorts, respectively, median overall survival was 16.1, 11.4, and 6.2 months, respectively; median locoregional progression-free survival was 9.9, 7.8, and 3.4 months, respectively; and median progression-free survival was 7.4, 5.1, and 2.5 months, respectively (P < 0.05 each). These findings suggest that PET/CT-based restaging may help select patients suitable for CRT, sparing those with metastases from futile radical protocols, and increasing the accuracy of estimated survival.Cancer Imaging 01/2013; 13(3):423-8. · 1.29 Impact Factor