title: Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer.
abstract: OBJECTIVE
  To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment.
  
  
  METHODS
  This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer.
  
  
  RESULTS
  The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 +/- 2.9 vs 7.8 +/- 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.
  
  
  CONCLUSIONS
  FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.
authors.affiliation: Department of Gastroenterological Surgery, Kagawa University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. hisao-w@med.kagawa-u.ac.jp
authors.forename: Hisao
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Otani
authors.forename: Takanori
authors.initials: T
authors.lastname: Sano
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Izuishi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18