title: Searching for indicators of malignancy in pancreatic intraductal papillary mucinous neoplasms: the value of 18FDG-PET confirmed.
abstract: BACKGROUND
  Malignancy in intraductal papillary mucinous neoplasms (IPMN) of the pancreas may be predicted on the basis of a number of clinical and radiologic features, which have raised sensitivity but result in a specificity as low as 20-50%. We sought to confirm the additional value of (18)F-18-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) in diagnostic accuracy of imaging-based IPMN malignancy assessment.
  
  
  METHODS
  This prospective uncontrolled case series contained 44 patients with IPMN undergoing comprehensive diagnostic evaluation, including magnetic resonance cholangiopancreatography and (18)FDG-PET. Average follow-up time was 39.3 months (range 3-97 months). Diagnostic performance regarding the diagnosis of malignancy was evaluated for the classic preoperative assessment, including clinical signs, CA 19-9, imaging (computed tomography and magnetic resonance cholangiopancreatography), and International Consensus Guidelines criteria, as well as (18)FDG-PET scan.
  
  
  RESULTS
  Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 22, 32, 100, and 43%, and 83, 100, 100, 94, and 96%, respectively, for comprehensive assessment without and with (18)FDG-PET [maximum standardized uptake value (SUV(max)) cutoff of 2.5 MBq]. Elevated CA 19-9 values and positive PET scan were the only independent prognostic factors for malignancy (odds ratio 2.11, 95% confidence interval 1.15-2.74 and 5.49, 95% confidence interval 3.98-21.44, respectively).
  
  
  CONCLUSIONS
  (18)FDG-PET is useful for detection of malignancy in IPMN, improving the differential diagnosis with benign cases by functional data. The choice of SUV(max) cutoff should maximize specificity.
authors: Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. baioksurg@hotmail.com
authors: Gian Luca
authors: GL
authors: Baiocchi
authors: Francesco
authors: F
authors: Bertagna
authors: Federico
authors: F
authors: Gheza
authors: Luigi
authors: L
authors: Grazioli
authors: David
authors: D
authors: Calanducci
authors: Raffaele
authors: R
authors: Giubbini
authors: Nazario
authors: N
authors: Portolani
authors: Stefano M
authors: SM
authors: Giulini
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging*; D000231:Adenocarcinoma, Papillary / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals
chemical_list: D018395:CA-19-9 Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18