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01-10-2017 | Original Article

Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma

Authors: Sampath Santhosh, Bhagwant Rai Mittal, Deepak Kumar Bhasin, Surinder Singh Rana, Rajesh Gupta, Ashim Das, Ritambhra Nada

Published in: Annals of Nuclear Medicine | Issue 8/2017

Abstract

Objective

To evaluate the additional role of FDG-PET/CT to the conventional multiphasic CECT in the initial staging of pancreatic adenocarcinoma.

Methods

54 patients diagnosed with pathologically proven pancreatic malignancy underwent FDG-PET/CECT. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal and metastatic staging were calculated. The statistical difference was calculated by McNemar’s test.

Results

Of 54 patients, 15 had distal metastasis. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal staging were 33 vs 89%, 84 vs 100%, 67 vs 100%, 60 vs 90%, and 59 vs 95%, respectively, p < 0.001. The sensitivity, specificity, PPV, NPV, and accuracy of CECT for metastatic staging were 73, 87, 69, 89, and 83%, whereas the accuracy of PET/CT was 100%, p = 0.01. By correctly characterizing unsuspected distant lesions, PET/CT could change management in 19% of patients.

Conclusion

FDG-PET/CT can contribute to change in the management in almost one of every five patients of PA evaluated with the standard investigations during the initial staging.

Tempero MA, Arnoletti JP, Behrman S, Ben-Josef E, Benson AB 3rd, Berlin JD, et al. Pancreatic adenocarcinoma: clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2010;8:972–1017.CrossRefPubMedPubMedCentral

Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet. 2004;363:1049–57.CrossRefPubMed

Wong TZ, Paulson EK, Nelson RC, Patz EF Jr, Coleman RE. Practical approach to diagnostic CT combined with PET. AJR Am J Roentgenol. 2007;188:622–9.CrossRefPubMed

Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg. 1995;221:59–66.CrossRefPubMedPubMedCentral

Barber TW, Kalff V, Cherk MH, Yap KS, Evans P, Kelly MJ. 18 F-FDG PET/CT influences management in patients with known or suspected pancreatic cancer. Intern Med J. 2011;41:776–83.CrossRefPubMed

Bares R, Klever P, Hauptmann S, Hellwig D, Fass J, Cremerius U, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology. 1994;192:79–86.CrossRefPubMed

Kauhanen SP, Komar G, Seppänen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250:957–63.CrossRefPubMed

Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R, et al. Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. Pancreas. 2013;42:11–9.CrossRefPubMed

Wang XY, Yang F, Jin C, Fu DL. Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 2014;20:15580–9.CrossRefPubMedPubMedCentral

10.

Strobel K, Heinrich S, Bhure U, Soyka J, Veit-Haibach P, Pestalozzi BC, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med. 2008;49:1408–13.CrossRefPubMed

11.

Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET)—usefulness and limitations in clinical reality. Ann Nucl Med. 2003;17:261–79.CrossRefPubMed

12.

Bang S, Chung HW, Park SW, Chung JB, Yun M, Lee JD, et al. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol. 2006;40:923–9.CrossRefPubMed

13.

Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, et al. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol. 2008;15:2465–71.CrossRefPubMed

14.

Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.CrossRefPubMed

15.

Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg. 1997;225:621–33.CrossRefPubMedPubMedCentral

16.

Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 2011;31:993–1015.CrossRefPubMed

17.

https://www.nccn.org/patients/guidelines/pancreatic/. Accessed 27 Dec 2016.

18.

John TG, Greig JD, Carter DC, Garden OJ. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg. 1995;221:156–64.CrossRefPubMedPubMedCentral

19.

Wang XY, Yang F, Jin C, Guan YH, Zhang HW, Fu DL. The value of 18F-FDG positron emission tomography/computed tomography on the pre-operative staging and the management of patients with pancreatic carcinoma. Hepatogastroenterology. 2014;61:2102–9.PubMed

20.

Burge ME, O’Rourke N, Cavallucci D, Bryant R, Francesconi A, Houston K, et al. A prospective study of the impact of fluorodeoxyglucose positron emission tomography with concurrent non-contrast CT scanning on the management of operable pancreatic and peri-ampullary cancers. HPB (Oxford). 2015;17:624–31.CrossRef

21.

Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224:748–56.CrossRefPubMed

22.

Chirindel A, Alluri KC, Chaudhry MA, Wahl RL, Pawlik TM, Herman JM, et al. Prognostic value of FDG PET/CT-derived parameters in pancreatic adenocarcinoma at initial PET/CT staging. AJR Am J Roentgenol. 2015;204:1093–9.CrossRefPubMed

Title: Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma
Authors: Sampath Santhosh
Bhagwant Rai Mittal
Deepak Kumar Bhasin
Surinder Singh Rana
Rajesh Gupta
Ashim Das
Ritambhra Nada
Publication date: 01-10-2017
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 8/2017
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-017-1193-0

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Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma

Abstract

Objective

Methods

Results

Conclusion

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Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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