The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer.
BACKGROUND
The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.


METHODS
(18)Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.


RESULTS
Overall, 21% of patients had a maximum standardized uptake value ≤ 3, and 60% of those had undergone neoadjuvant treatment (P=0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P=0.112).


CONCLUSIONS
The widespread application of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9>200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.
Division of Pancreatic Surgery, Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
Stefano
S
Crippa
Department of Nuclear Medicine, University of Verona, Negrar, Italy.
Matteo
M
Salgarello
Residency Programme in Surgery, University of Verona, Italy.
Silvia
S
Laiti
Division of Pancreatic Surgery, Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
Stefano
S
Partelli
Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar, Italy.
Paola
P
Castelli
Department of Medical Physics and Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.
Antonello E
AE
Spinelli
Residency Programme in Surgery, University of Verona, Italy.
Domenico
D
Tamburrino
Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar, Italy.
Giuseppe
G
Zamboni
Division of Pancreatic Surgery, Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: m.falconi@univpm.it.
Massimo
M
Falconi
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D018395:CA-19-9 Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Computed tomography; Liver; Lymph node; Metastases; Pancreatic cancer; Positron emission tomography; Staging