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Insights into Imaging

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Open Access 01-10-2013 | Original Article

Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours

Authors: Raneem Albazaz, Chirag N. Patel, Fahmid U. Chowdhury, Andrew F. Scarsbrook

Published in: Insights into Imaging | Issue 5/2013

Abstract

Objectives

To assess the impact on clinical management of introducing ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-computed tomography (CT) in to the work-up of patients with primary and recurrent biliary malignancy.

Methods

Consecutive patients with primary biliary tumours undergoing FDG PET-CT at a single large tertiary referral centre between November 2007 and September 2010 were retrospectively analysed. Findings on FDG PET-CT compared with CT/magnetic resonance imaging (MRI) and impact on subsequent patient management were evaluated. Impact was divided into: (1) major—detection of occult disease or characterisation of indeterminate lesion(s) on CT/MRI; (2) minor—confirmation of suspected metastases seen on CT/MRI; (3) no impact.

Results

One hundred and eleven patients underwent 118 FDG PET-CT scans, including 30 with suspected gallbladder carcinoma and 81 with cholangiocarcinoma. Eighty-nine scans were performed for initial staging, five for restaging following neoadjuvant chemotherapy and 24 for suspected disease recurrence. In 33 cases (28 %), FDG PET-CT had a major impact on subsequent patient management (39 % gallbladder carcinoma, 26 % intrahepatic cholangiocarcinoma and 21 % extrahepatic cholangiocarcinoma). FDG PET-CT had a minor impact in 20 cases (17 %) and no impact in 65 cases (55 %).

Conclusions

By detecting occult metastatic disease and characterising indeterminate lesions, FDG PET-CT can have a major influence on clinical decision-making in primary and recurrent biliary malignancy.

Alberts SR, Gores GJ, Kim GP et al (2007) Treatment options for hepatobiliary and pancreatic cancer. Mayo Clin Proc 82:628–637PubMedCrossRef

Gaujoux S, Allen PJ (2010) Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World J Gastrointest 2:283–290CrossRef

Weitz J, D'Angelica M, Jarnagin W, Gonen M, Fong Y, Blumgart L, Dematteo R (2004) Selective use of diagnostic laparoscopy prior to planned hepatectomy for patients with hepatocellular carcinoma. Surgery 135:273–281PubMedCrossRef

Goere D, Wagholikar GD, Pessaux P et al (2006) Utility of staging laparoscopy in subsets of biliary cancers: laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma. Surg Endosc 20:721–725PubMedCrossRef

Keidar Z, Haim N, Guralnik L, Wollner M, Bar-Shalom R, Ben-Nun A, Israel O (2004) PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 45:1640–1646PubMed

Votrubova J, Belohlavek O, Jaruskova M et al (2006) The role of FDG-PET/CT in the detection of recurrent colorectal cancer. Eur J Nucl Med Mol Imaging 33:779–784PubMedCrossRef

Bruzzi JF, Munden RF, Truong MT et al (2007) PET/CT of esophageal cancer: its role in clinical management. Radiographics 27:1635–1652PubMedCrossRef

Hillner BE, Siegel BA, Shields AF et al (2008) Relationship between cancer type and impact of PET and PET/CT on intended management: findings of the National Oncologic PET Registry. J Nucl Med 49:1928–1935PubMedCrossRef

Corvera CU, Blumgart LH, Akhurst T et al (2008) 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg 206:57–65PubMedCrossRef

10.

Petrowsky H, Wildbrett P, Husarik DB et al (2006) Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol 45:43–50PubMedCrossRef

11.

Lee SW, Kim HJ, Park JH et al (2010) Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol 45:560–566PubMedCrossRef

12.

Hueman MT, Vollmer CM Jr, Pawlik TM (2009) Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 16:2101–2115PubMedCrossRef

13.

Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D (2004) Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg 8:90–97PubMedCrossRef

14.

Wakabayashi H, Akamoto S, Yachida S, Okano K, Izuishi K, Nishiyama Y, Maeta H (2005) Significance of fluorodeoxyglucose PET imaging in the diagnosis of malignancies in patients with biliary stricture. Eur J Surg Oncol 31:1175–1179PubMedCrossRef

15.

Koh T, Taniguchi H, Yamaguchi A, Kunishima S, Yamagishi H (2003) Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine-18-labeled fluoro-deoxyglucose (FDG-PET). J Surg Oncol 84:74–78PubMedCrossRef

16.

Rodríguez-Fernández A, Gómez Río M, Llamas Elvira JM et al (2004) Positron-emission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis. Am J Surg 188:171–175PubMedCrossRef

17.

Kim JY, Kim MH, Lee TY et al (2008) Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol 103:1145–1151PubMedCrossRef

18.

Jadvar H, Henderson RW, Conti PS (2007) [F-18]fluorodeoxyglucose positron emission tomography and positron emission tomography: computed tomography in recurrent and metastatic cholangiocarcinoma. J Comput Assist Tomogr 31:223–228PubMedCrossRef

19.

Moon CM, Bang S, Chung JB et al (2008) Usefulness of 18F-fluorodeoxyglucose positron emission tomography in differential diagnosis and staging of cholangiocarcinomas. J Gastroenterol Hepatol 23:759–765PubMedCrossRef

20.

Li J, Kuehl H, Grabellus F et al (2008) Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol 98:438–443PubMedCrossRef

21.

Prytz H, Keiding S, Björnsson E, Broomé U, Almer S, Castedal M, Munk OL, Swedish Internal Medicine Liver Club (2006) Dynamic FDG-PET is useful for detection of cholangiocarcinoma in patients with PSC listed for liver transplantation. Hepatology 44:1572–1580PubMedCrossRef

22.

Fevery J, Buchel O, Nevens F, Verslype C, Stroobants S, Van Steenbergen W (2005) Positron emission tomography is not a reliable method for the early diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis. J Hepatol 43:358–361PubMedCrossRef

23.

Culverwell AD, Scarsbrook AF, Chowdhury FU (2011) False positive uptake on 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging. Clin Radiol 66:366–382PubMedCrossRef

Title: Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours
Authors: Raneem Albazaz
Chirag N. Patel
Fahmid U. Chowdhury
Andrew F. Scarsbrook
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 5/2013
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-013-0268-2

At a glance: The STEP trials

Springer Medicine

Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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