title: Diagnostic impact of 18F-FDG PET-CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound.
abstract: OBJECTIVE
  This prospective single-centre phase II trial assessed the diagnostic impact of (18)F-FDG PET-CT in the evaluation of solid pancreatic lesions (phi >or= 10 mm) compared to endosonography (EUS), endoscopic retrograde cholangio-pancreatography (ERCP) with intraductal ultrasound (IDUS), abdominal ultrasound (US) and histopathological reference.
  
  
  METHODS
  Forty-six patients (32 men/14 women, phi 61.7 years) with suspected pancreatic neoplasms underwent PET-CT with contrast-enhanced biphasic multi-detector CT of the upper abdomen followed by a diagnostic work-up with EUS, ERCP with IDUS and US within 3 weeks. PET-CT data sets were analysed by two expert readers in a consensus reading. Histology from surgery, biopsy/fine-needle aspiration and/or clinical follow-up >or=12 months served as standard of reference.
  
  
  RESULTS
  Twenty-seven pancreatic malignancies were histopathologically proven; 19 patients had benign diseases: 36/46 lesions (78%) were detected in the head of the pancreas, 7/46 and 3/46 in the body and tail region, respectively. Sensitivity and specificity of PET-CT were 89% and 74%, respectively; positive predictive value (PPV) and negative predictive value (NPV) were 83% and 82%, respectively. Sensitivity (81-89%), specificity (74-88%), PPV (83-90%) and NPV (77-82%) achieved by EUS, ERCP and US were not significantly different. PET analysis revealed significantly higher maximum mean standardised uptake values (SUV(max) 6.5+/-4.6) in patients with pancreatic malignancy (benign lesions: SUV(max) 4.2+/-1.5; p<0.05). PET-CT revealed cervical lymphonodal metastasis from occult bronchogenic carcinoma and a tubular colon adenoma with intermediate dysplasia on polypectomy, respectively.
  
  
  CONCLUSIONS
  (18)F-FDG PET-CT achieves a comparably high diagnostic impact evaluating small solid pancreatic lesions versus conventional reference imaging modalities. Additional clinical diagnoses are derived from concomitant whole-body PET-CT imaging.
authors.affiliation: Department of Medicine B, Muenster University Hospital, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Schick
authors.forename: Christiane
authors.initials: C
authors.lastname: Franzius
authors.forename: Torsten
authors.initials: T
authors.lastname: Beyna
authors.forename: May Lin
authors.initials: ML
authors.lastname: Oei
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schnekenburger
authors.forename: Matthias
authors.initials: M
authors.lastname: Weckesser
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Otmar
authors.initials: O
authors.lastname: Schober
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Pohle
authors.forename: Kai Uwe
authors.initials: KU
authors.lastname: Juergens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18