title: Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness.
abstract: OBJECTIVE
  We sought to determine the impact of positron emission tomography/computed tomography (PET/CT) on the management of presumed resectable pancreatic cancer and to assess the cost of this new staging procedure.
  
  
  BACKGROUND
  PET using 18F-fluorodeoxyglucose (FDG) is increasingly used for the staging of pancreatic cancer, but anatomic information is limited. Integrated PET/CT enables optimal anatomic delineation of PET findings and identification of FDG-negative lesions on computed tomography (CT) images and might improve preoperative staging.
  
  
  METHODS
  Patients with suspected pancreatic cancer who had a PET/CT between June 2001 to April 2004 were entered into a prospective database. Routine staging included abdominal CT, chest x-ray, and CA 19-9 measurement. FDG-PET/CT was conducted according to a standardized protocol, and findings were confirmed by histology. Cost benefit analysis was performed based on charged cost of PET/CT and pancreatic resection and included the time frame of staging and surgery.
  
  
  RESULTS
  Fifty-nine patients with a median age of 61 years (range, 40-80 years) were included in this analysis. Fifty-one patients had lesions in the head and 8 in the tail of the pancreas. The positive and negative predictive values for pancreatic cancer were 91% and 64%, respectively. PET/CT detected additional distant metastases in 5 and synchronous rectal cancer in 2 patients. PET/CT findings changed the management in 16% of patients with pancreatic cancer deemed resectable after routine staging (P = 0.031) and was cost saving.
  
  
  CONCLUSIONS
  PET/CT represents an important staging procedure prior to pancreatic resection for cancer, since it significantly improves patient selection and is cost-effective.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinrich
authors.forename: Gerhard W
authors.initials: GW
authors.lastname: Goerres
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
authors.forename: Markus
authors.initials: M
authors.lastname: Sagmeister
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Pestalozzi
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hany
authors.forename: Gustav K
authors.initials: GK
authors.lastname: von Schulthess
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D049268:Positron-Emission Tomography / Q000191:economics; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics
chemical_list: D019788:Fluorodeoxyglucose F18