title: Clinical utility of positron emission tomography in the diagnosis and management of periampullary neoplasms.
abstract: BACKGROUND
  This study examined the effect that 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) imaging had on the clinical management of patients with suspected periampullary malignancy.
  
  
  METHODS
  Fifty-four patients with suspected pancreatic neoplasms underwent both whole-body (18)FDG-PET and abdominal computed tomography (CT). Malignant or benign disease was confirmed pathologically in 47 patients.
  
  
  RESULTS
  Of the 41 patients with malignancy, (18)FDG-PET failed to identify the primary tumor in 5 patients. (18)FDG-PET demonstrated increased uptake suggesting primary malignancy in 37 patients. Malignant pathology was confirmed in 36 cases. (18)FDG-PET identified malignant locoregional lymph node metastases in six of ten patients. All nodes identified before surgery by (18)FDG-PET were also seen on preoperative CT. Six patients who were thought to have resectable disease by CT were found to have distant metastasis at laparotomy. (18)FDG-PET did not detect metastasis in any of these cases. Before surgery, (18)FDG-PET identified distant metastases that were not detected by CT in one patient.
  
  
  CONCLUSIONS
  Despite high sensitivity and specificity in diagnosing periampullary malignancy, (18)FDG-PET did not change clinical management in the vast majority of patients previously evaluated by CT. In addition, (18)FDG-PET missed >10% of periampullary malignancies and did not provide the anatomical detail necessary to define unresectabilty.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Kalady
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Clark
authors.forename: Marcia
authors.initials: M
authors.lastname: Gottfried
authors.forename: Eric M
authors.initials: EM
authors.lastname: Rohren
authors.forename: R Edward
authors.initials: RE
authors.lastname: Coleman
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D014670:Ampulla of Vater / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18