Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness.
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.
Heinrich
Stefan
S
Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Switzerland.
Goerres
Gerhard W
GW
Schäfer
Markus
M
Sagmeister
Markus
M
Bauerfeind
Peter
P
Pestalozzi
Bernhard C
BC
Hany
Thomas F
TF
von Schulthess
Gustav K
GK
Clavien
Pierre-Alain
PA
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
D019788:Fluorodeoxyglucose F18