Skip to main content

Advertisement

SpringerLink
Log in

PET/CT Fusion Scan Enhances CT Staging in Patients with Pancreatic Neoplasms

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of fusion positron emission tomography/computed tomography scans (PET/CT) in staging of patients with pancreatic neoplasms (PN) is poorly defined. PET/CT may serve as an adjunct to standard imaging by increasing occult metastases detection. The purpose of this study was to assess the additional value, in relation to computed tomography (CT), of PET/CT imaging for patients with PN.

Methods

Eighty-two patients with potentially resectable PN underwent staging with PET/CT and CT of the chest and abdomen. Sensitivity of diagnosing pancreatic cancer by PET/CT avidity was evaluated. The sensitivity of detecting metastases was compared between PET/CT, standard CT, and the combination of PET/CT and CT. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT.

Results

The sensitivity and specificity of PET/CT in diagnosing pancreatic cancer were 89% and 88%, respectively. Sensitivity of detecting metastatic disease for PET/CT alone, standard CT alone, and the combination of PET/CT and CT were 61%, 57%, and 87%, respectively. Findings on PET/CT influenced the clinical management in seven patients (11%), two with a supraclavicular lymph node (LN), two occult liver lesions, two peritoneal implants, and one peri-esophageal LN.

Conclusion

This study evaluated PET/CT in the initial work-up of patients with PN. PET/CT increased sensitivity (87%) for detection of metastatic disease when combined with standard CT. In invasive cancer, PET/CT changed the management in 11% of our patients. PET/CT should be considered in the initial work-up of patients with potentially resectable pancreatic lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin. Feb 20 2008

  2. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007; 297:267–77

    Article  PubMed  CAS  Google Scholar 

  3. Regine WF, Winter KA, Abrams RA, et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008; 299:1019–26

    Article  PubMed  CAS  Google Scholar 

  4. Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987; 59:2006–10

    Google Scholar 

  5. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350:1200–10

    Article  PubMed  CAS  Google Scholar 

  6. Abdel-Nabi H, Doerr RJ, Lamonica DM, et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998; 206:755–60

    PubMed  CAS  Google Scholar 

  7. Ruers TJ, Langenhoff BS, Neeleman N, et al. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol 2002; 20:388–95

    Article  PubMed  CAS  Google Scholar 

  8. Brady MS, Akhurst T, Spanknebel K, et al. Utility of preoperative [(18)]f fluorodeoxyglucose-positron emission tomography scanning in high-risk melanoma patients. Ann Surg Oncol 2006; 13:525–32

    Article  PubMed  Google Scholar 

  9. Bruzzi JF, Munden RF, Truong MT, et al. PET/CT of esophageal cancer: its role in clinical management. Radiographics 2007; 27:1635–52

    Article  PubMed  Google Scholar 

  10. Zimny M, Bares R, Fass J, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med 1997; 24:678–82

    PubMed  CAS  Google Scholar 

  11. Imdahl A, Nitzsche E, Krautmann F, et al. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg 1999; 86:194–9

    Article  PubMed  CAS  Google Scholar 

  12. Kalra MK, Blake MA, Saini S. Role of dual PET/CT scanning in abdominal malignancies. Cancer Imaging 2004; 4:121–3

    Article  PubMed  Google Scholar 

  13. Zimny M, Buell U. 18FDG-positron emission tomography in pancreatic cancer. Ann Oncol 1999; 10(Suppl 4):28–32

    Article  PubMed  Google Scholar 

  14. Keogan MT, Tyler D, Clark L, et al. Diagnosis of pancreatic carcinoma: role of FDG PET. AJR Am J Roentgenol 1998; 171:1565–70

    PubMed  CAS  Google Scholar 

  15. Heinrich S, Goerres GW, Schafer M, et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005; 242:235–43

    Article  PubMed  Google Scholar 

  16. Ruers TJ, Langenhoff BS, Neeleman N, et al. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol 2002; 20:388–95

    Article  PubMed  CAS  Google Scholar 

  17. Mansour JC, Schwartz L, Pandit-Taskar N, et al. The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas. J Gastrointest Surg 2006; 10:1354–60

    Article  PubMed  Google Scholar 

  18. Frohlich A, Diederichs CG, Staib L, et al. Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 1999; 40:250–5

    PubMed  CAS  Google Scholar 

  19. Jadvar H, Fischman AJ. Evaluation of pancreatic carcinoma with FDG PET. Abdom Imaging 2001; 26:254–9

    Article  PubMed  CAS  Google Scholar 

  20. Maemura K, Takao S, Shinchi H, et al. Role of positron emission tomography in decisions on treatment strategies for pancreatic cancer. J Hepatobiliary Pancreat Surg 2006; 13:435–41

    Article  PubMed  Google Scholar 

  21. Sloka JS, Hollett PD. Cost effectiveness of positron emission tomography in Canada. Med Sci Monit 2005; 11:PH1–6

    PubMed  Google Scholar 

  22. Maisey NR, Webb A, Flux GD, et al. FDG-PET in the prediction of survival of patients with cancer of the pancreas: a pilot study. Br J Cancer 2000; 83:287–93

    Article  PubMed  CAS  Google Scholar 

  23. Chin BB, Wahl RL. 18F-Fluoro-2-deoxyglucose positron emission tomography in the evaluation of gastrointestinal malignancies. Gut 2003; 52(Suppl 4):iv23–9

    PubMed  Google Scholar 

  24. Rose DM, Delbeke D, Beauchamp RD, et al. 18Fluorodeoxyglucose-positron emission tomography in the management of patients with suspected pancreatic cancer. Ann Surg 1999; 229:729–37; discussion 737–8

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Jeffrey M. Farma MD, Alfredo A. Santillan MD, MPH, Marcovalerio Melis MD, Janet Walters RN, CCM, Daly Belinc RN, BSN & Mokenge Malafa MD

  2. Department of Biostatistics, Moffitt Cancer Center & Research Institute, Tampa, FL, USA

    Dung-Tsa Chen PhD

  3. Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Edward A. Eikman MD

  4. Department of Gastrointestinal Oncology, Section of Pancreatic Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Mokenge Malafa MD

Authors
  1. Jeffrey M. Farma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alfredo A. Santillan MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcovalerio Melis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janet Walters RN, CCM
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daly Belinc RN, BSN
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dung-Tsa Chen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edward A. Eikman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mokenge Malafa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mokenge Malafa MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farma, J.M., Santillan, A.A., Melis, M. et al. PET/CT Fusion Scan Enhances CT Staging in Patients with Pancreatic Neoplasms. Ann Surg Oncol 15, 2465–2471 (2008). https://doi.org/10.1245/s10434-008-9992-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-9992-0

Keywords

Search

Navigation