title: Staging chest computed tomography and positron emission tomography in patients with pancreatic adenocarcinoma: utility or futility?
abstract: OBJECTIVE
  This study was conducted to determine if routine staging chest computed tomography (CT) or positron emission tomography (PET) scanning alters the clinical management of patients with newly diagnosed pancreatic adenocarcinoma.
  
  
  METHODS
  All new pancreas cancers seen in medical oncology, radiation oncology and surgery from 1 June 2008 to 20 June 2010 were retrospectively reviewed. Patients with metastatic disease on chest CT or PET, that had been unsuspected on initial imaging, were identified.
  
  
  RESULTS
  Pancreatic adenocarcinoma was present in 247 consecutive patients. Abdominal CT demonstrated metastases in 108 (44%) and localized disease in 139 (56%) patients. Chest CT and PET were not performed in 15 (11%) of these 139 patients. In the remaining 124 patients, CT imaging suggested resectable disease in 46, borderline resectable disease in 52 and locally advanced disease in 26 patients. Chest CT demonstrated an unsuspected lymphoma in one patient with borderline resectable disease and PET identified extrapancreatic disease in two patients with locally advanced disease. Chest CT and PET added no information in 121 (98%) of the 124 patients.
  
  
  CONCLUSIONS
  The addition of chest CT and PET to high-quality abdominal CT is of little clinical utility; additional sites of metastasis are rarely found. As the quality of abdominal imaging declines, the yield from other imaging modalities will increase. Dedicated pancreas-specific abdominal CT remains the cornerstone of initial staging in suspected or biopsy-proven pancreatic cancer.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Sam G
authors.initials: SG
authors.lastname: Pappas
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Parag P
authors.initials: PP
authors.lastname: Tolat
authors.forename: Alan P
authors.initials: AP
authors.lastname: Mautz
authors.forename: Alysandra
authors.initials: A
authors.lastname: Lal
authors.forename: Lisa
authors.initials: L
authors.lastname: McElroy
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.forename: Paul
authors.initials: P
authors.lastname: Ritch
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D006801:Humans; D018447:Medical Futility; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures