title: Clinical role of (18)F-FDG PET for initial staging of patients with extrahepatic bile duct cancer.
abstract: In extrahepatic bile duct cancer, preoperative evaluation is important because only surgical excision of all detectable tumours is associated with improvement in 5-year survival. However, morphological imaging techniques, including computed tomography (CT), are still insufficient for accurate staging. The purpose of this study was to assess the additional value, in relation to CT, of 2-[(18)F]fluoro-2-deoxy- D-glucose positron emission tomography ((18)F-FDG PET) for the evaluation of extrahepatic bile duct cancer. Thirty patients with extrahepatic bile duct cancer underwent both (18)F-FDG PET and CT for initial staging. The results of the two modalities for evaluation of primary tumours and regional lymph nodes were compared with the final diagnoses based on pathological or clinical findings. The primary tumours were interpreted as malignant on the basis of CT in 24 (80%) of the patients, while (18)F-FDG PET revealed increased (18)F-FDG uptake in 18 (60%) of them. On the other hand, (18)F-FDG PET showed focal accumulation of (18)F-FDG in the bile duct in three of the six patients with equivocal findings on CT. The sensitivity, specificity and accuracy of CT for regional lymph node metastases were 54%, 59% and 57%, while those of (18)F-FDG PET were 38%, 100% and 73%, respectively. The specificity of (18)F-FDG PET for regional lymph node metastases was significantly higher than that of CT ( P<0.01). Of 14 patients with N1 or N2 disease diagnosed by CT, only seven (50%) had a final diagnosis of regional lymph node metastasis. In these 14 patients, (18)F-FDG PET accurately evaluated the N component of the disease in 12 patients (86%). In conclusion, in the initial staging of patients with extrahepatic bile duct cancer, (18)F-FDG PET offers additional value in relation to CT in evaluating both the primary tumour and regional lymph nodes.
authors.affiliation: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 6, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
authors.forename: Eriko
authors.initials: E
authors.lastname: Tsukamoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kuge
authors.forename: Chietsugu
authors.initials: C
authors.lastname: Katoh
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Nambu
authors.forename: Aichiro
authors.initials: A
authors.lastname: Nobuta
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011859:Radiography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18