title: Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma.
abstract: OBJECTIVE
  (1) To evaluate the diagnostic value of integrated positron emission and computed tomography (PET/CT) in comparison with contrast-enhanced CT (ceCT) to detect biliary tract tumors and associated distant and regional lymph node metastases and (2) to evaluate the impact of PET/CT on therapy management.
  
  
  METHODS
  From January 2001 to March 2005, each patient who was treated for a malignancy of the biliary tract underwent PET/CT examination in addition to the standard work-up imaging. Data were prospectively collected and analyzed in comparison with ceCT.
  
  
  RESULTS
  Sixty-one patients with malignancies of the biliary tract were included into the study. Diagnosis was proven in all patients either by histology or cytology. PET/CT detected all gallbladder cancers (n=14). PET/CT and ceCT provided a comparable accuracy for the primary intra- (n=14) and extra-hepatic cholangiocarcinomas (n=33). All distant metastases (12/12) were detected by PET/CT, but only 3/12 by ceCT (p<0.001). Regional lymph node metastases were detected by PET/CT and ceCT in only 12% vs. 24%. PET/CT findings resulted in a change of management in 17% of patients deemed resectable after standard work-up.
  
  
  CONCLUSIONS
  PET/CT is particularly valuable in detecting unsuspected distant metastases which are not diagnosed by standard imaging. Thus, PET/CT staging has an important impact on selection of adequate therapy.
authors.affiliation: Swiss HPB (Hepato-Pancreato-Biliary) Center, Department of Visceral and Transplant Surgery, University Hospital Zurich, Switzerland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Peer
authors.initials: P
authors.lastname: Wildbrett
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Husarik
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hany
authors.forename: Simona
authors.initials: S
authors.lastname: Tam
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D017734:Bile Ducts, Extrahepatic; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012008:Recurrence; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed