title: 18 F-FDG PET/CT influences management in patients with known or suspected pancreatic cancer.
abstract: BACKGROUND
  The aims of this study were (i) to assess and validate the incremental information of positron emission tomography/computed tomography (PET/CT) over conventional staging investigations (CSI) and (ii) to assess the management impact of PET/CT in patients with known or suspected pancreatic cancer.
  
  
  METHODS
  Between October 2007 and September 2008, 22 PET/CT scans were performed using a dedicated PET/CT scanner in 21 patients with known or suspected pancreatic cancer. Follow up was used to reconcile discordance between PET/CT and CSI. The pre-PET/CT management plan and/or intent were prospectively recorded in all scans. The post-PET/CT management plan was determined from the medical record and/or discussions with treating clinicians. The management impact of PET/CT was classified as high, medium, low or none defined using Australian and New Zealand Association of Physicians in Nuclear Medicine PET data collection project criteria.
  
  
  RESULTS
  PET/CT and CSI were discordant in 14/22 (64%: 95% CI; 43-84%) scans. Of the 14 discordant scans, PET/CT assessment was correct in eight, conventional imaging in four and there was insufficient information in two. Overall, PET/CT management impact was classified as high (n= 6), medium (n= 3), low (n= 9) or none (n= 4). Significant changes in management (high or medium impact) were induced by PET/CT in 9/22 scans (41%: 95% CI; 20-62%) predominantly by correctly modifying the disease extent.
  
  
  CONCLUSIONS
  PET/CT has an incremental benefit over CSI and has a significant impact on management in patients with known or suspected pancreatic cancer. PET/CT merits consideration as part of the non-invasive evaluation of patients with known or suspected pancreatic cancer.
authors.affiliation: Departments of Nuclear Medicine and PET Centre, The Alfred Hospital, Melbourne, Victoria, Australia. tomwbarber@yahoo.com.au
authors.forename: T W
authors.initials: TW
authors.lastname: Barber
authors.forename: V
authors.initials: V
authors.lastname: Kalff
authors.forename: M H
authors.initials: MH
authors.lastname: Cherk
authors.forename: K S K
authors.initials: KS
authors.lastname: Yap
authors.forename: P
authors.initials: P
authors.lastname: Evans
authors.forename: M J
authors.initials: MJ
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods* / Q000592:standards; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18