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.
- SourceAvailable from: Ewout W Steyerberg[Show abstract] [Hide abstract]
ABSTRACT: Gastrojejunostomy (GJJ) and duodenal stent placement are the most commonly used palliative treatment modalities for gastric outlet obstruction (GOO). In this retrospective study, we compared GJJ and stent placement with regard to medical effects. Medical records of 95 patients who had undergone palliative treatment between 1994 and 2006 in a Dutch university hospital, were reviewed. Study outcomes were improvement of food intake, complications, persistent and recurrent symptoms, re-interventions, hospital stay, and survival. Fifty-three patients were referred for duodenal stent placement and 42 patients underwent GJJ. There were no differences in technical and clinical success and the incidence of minor and early major complications and survival. Food intake improved more rapidly after stent placement than GJJ (P = 0.01). The time to late major complications, recurrent obstructive symptoms and re-intervention was significantly shorter after stent placement than GJJ (P = 0.004, 0.002, and 0.004, respectively). Hospital stay was also shorter after stent placement than GJJ (P < 0.001). These findings suggest that stent placement is associated with better short-term outcomes and GJJ with better long-term outcomes. A large randomized controlled trial is however needed to systematically compare stent placement with GJJ with regard to medical effects, quality of life and costs.Journal of Surgical Oncology 10/2007; 96(5):389-96. DOI:10.1002/jso.20828 · 2.84 Impact Factor
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ABSTRACT: ERCP on an outpatient basis could be as safe as on an inpatient basis and may also reduce medical costs. To review the available literature to determine the safety of an ERCP performed on an outpatient basis. A review of the published literature was performed by searching PubMed, the Cochrane Library, EMBASE, and the Web of Science. Patients who were undergoing an ERCP. An ERCP on an inpatient or outpatient basis. Patient and treatment characteristics, complications, and prolonged hospital admissions and readmissions. Eleven studies were included in this review, of which 5 were comparative studies, 5 were prospective studies, and 1 was a retrospective study. In these series, a total of 2483 patients underwent an ERCP on an outpatient basis and 2320 patients were admitted overnight after an ERCP. Complications were seen in 184 of 2483 outpatients (7%), of which 72% of complications (107/149) presented within 2 to 6 hours, 10% (15/149) within 6 to 24 hours, and 18% (27/149) more than 24 hours after the ERCP. Three percent of the inpatients (82/2320) developed a complication, of which 95% of complications (78/82) presented within 24 hours and 5% (4/82) presented more than 24 hours after the ERCP. A prolonged hospital stay after an ERCP was indicated in 6% of the designated outpatients (148/2483), whereas 3% of outpatients (74/2149) and <1% of inpatients (4/2320) were readmitted after discharge. Limited data available. This review shows that, with a selective policy, an ERCP on an outpatient basis seems as safe as when performed on an inpatient basis.Gastrointestinal endoscopy 07/2008; 68(1):118-23. DOI:10.1016/j.gie.2007.11.035 · 4.90 Impact Factor
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ABSTRACT: Increased expression of glucose transporters has been reported in many cancers. It is not known whether Sodium dependent GLucose Transporter 1 (SGLT1) is up-regulated in pancreatic cancer. We studied the expression of SGLT1, Bcl-2 and p53 in primary pancreatic adenocarcinomas related to survival. In primary tumors, mean SGLT1-Hscore (n = 83) was 4.24 (median 3.0, range 0.5-15.0). Patients with positive staining for Bcl-2 had higher mean SGLT1-Hscores than those without Bcl-2 expression: 5.87 vs. 3.07 (P = 0.025). No correlation was found between expression of p53 and SGLT1 (P = 0.881). On multivariate analysis TNM stage (P = 0.015) and SGLT1 (P = 0.030) showed prognostic value for disease free survival (DFS). For overall survival (OS), TNM stage (P<0.001) and chemotherapy (P = 0.048) were prognostic and SGLT1 showed a trend (P = 0.071). In a subgroup of younger patients (age < or = median, 63.9 y) who did not receive chemotherapy, SGLT1 was a very strong predictor of DFS (P = 0.005). We conclude that high SGLT1 expression (H score > median, 3.0) in pancreatic adenocarcinomas was significantly correlated with DFS and a trend was found for OS, especially in younger patients. High SGLT1 expression in primary tumors was correlated with high Bcl-2 expression, not with p53 expression. This supports our hypothesis that SGLT1 and Bcl-2 expression could serve as prognostic markers in pancreatic cancer.Cancer Investigation 10/2008; 26(8):852-9. DOI:10.1080/07357900801956363 · 2.06 Impact Factor