A prospective study of the impact of fluorodeoxyglucose positron emission tomography with concurrent non-contrast CT scanning on the management of operable pancreatic and peri-ampullary cancers.
BACKGROUND
The role of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) scanning in operable pancreas cancer is unclear. We, therefore, wanted to investigate the impact of PET/CT on management, by incorporating it into routine work-up.


METHODS
This was a single-institution prospective study. Patients with suspected and potentially operable pancreas, distal bile duct or ampullary carcinomas underwent PET/CT in addition to routine work-up. The frequency that PET/CT changed the treatment plan or prompted other investigations was determined. The distribution of standard uptake values (SUV) among primary tumours, and adjacent to biliary stents was characterised.


RESULTS
Fifty-six patients were recruited. The surgical plan was abandoned in 9 (16%; 95% CI: 6-26) patients as a result of PET/CT identified metastases. In four patients, metastases were missed and seven were inoperable at surgery, not predicted by PET/CT. Unexpected FDG uptake resulted in seven additional investigations, of which two were useful. Among primary pancreatic cancers, a median SUV was 4.9 (range 2-12.1). SUV was highest around the biliary stent in 17 out of 28 cases. PET/CT detected metastases in five patients whose primary pancreatic tumours demonstrated mild to moderate avidity (SUV < 5).


CONCLUSIONS
PET/CT in potentially operable pancreas cancer has limitations. However, as a result of its ability to detect metastases, PET/CT scanning is a useful tool in the selection of such patients for surgery.
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Matthew E
ME
Burge
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Nick
N
O'Rourke
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
David
D
Cavallucci
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Richard
R
Bryant
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Alessandra
A
Francesconi
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Kathleen
K
Houston
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
David
D
Wyld
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Melissa
M
Eastgate
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Robert
R
Finch
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
George
G
Hopkins
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
Paul
P
Thomas
Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
David
D
Macfarlane
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011793:Queensland; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18