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A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer.
Ann Surg. 2009 Dec; 250(6):957-63.AnnS

Abstract

OBJECTIVE

To prospectively compare the accuracy of combined positron emission tomography/computed tomography using F-fluorodeoxyglucose (FDG-PET/CT), multidetector row computed tomography (MDCT), and magnetic resonance imaging (MRI) in the evaluation of patients with suspected pancreatic malignancy.

SUMMARY BACKGROUND DATA

FDG-PET/CT imaging is increasingly used for staging of pancreatic cancer. Preliminary data suggest a significant influence of FDG-PET/CT on treatment planning, although its role is still evolving.

METHODS

Thirty-eight consecutive patients with suspicion of pancreatic malignancy were enrolled. Patients underwent a protocol including FDG-PET/CT, MDCT, and MRI combined with magnetic resonance cholangiopancreatography, all of which were blindly evaluated. The findings were confirmed macroscopically at operation and/or by histopathologic analysis (n = 29) or follow-up (n = 9). Results of TNM classification of different imaging methods were compared with clinical TNM classification.

RESULTS

Pancreatic adenocarcinoma was diagnosed in 17 patients, neuroendocrine tumor in 3, mass-forming pancreatitis in 4, cystic lesion in 6, and fibrosis in 2. Six patients had a finding of a normal pancreas. The diagnostic accuracy of FDG-PET/CT for pancreatic malignancy was 89%, compared with 76% and 79% for MDCT and MRI, respectively. In the differential diagnosis of suspected malignant biliary stricture at endoscopic retrograde cholangiopancreaticography (n = 21), FDG-PET/CT had a positive predictive value of 92%. In 17 patients with advanced pancreatic adenocarcinoma, FDG-PET/CT had a sensitivity of 30% for N- and 88% for M-staging. Both MDCT and MRI had sensitivities of 30% for N- and 38% for M-staging. Furthermore, the clinical management of 10 patients (26%) was altered after FDG-PET/CT.

CONCLUSION

FDG-PET/CT was more sensitive than conventional imaging in the diagnosis of both primary pancreatic adenocarcinoma and associated distant metastases. In contrast, the sensitivity of FDG-PET/CT was poor in detecting local lymph node metastasis, which would have been important for an assessment of resectability. We recommend the use of FDG-PET/CT in the evaluation of diagnostically challenging cases, especially in patients with biliary strictures without evidence of malignancy in conventional imaging.

Authors+Show Affiliations

Turku PET Centre, Turku University Hospital, Turku, Finland. saila.kauhanen@tyks.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19687736

Citation

Kauhanen, Saila P., et al. "A Prospective Diagnostic Accuracy Study of 18F-fluorodeoxyglucose Positron Emission Tomography/computed Tomography, Multidetector Row Computed Tomography, and Magnetic Resonance Imaging in Primary Diagnosis and Staging of Pancreatic Cancer." Annals of Surgery, vol. 250, no. 6, 2009, pp. 957-63.
Kauhanen SP, Komar G, Seppänen MP, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250(6):957-63.
Kauhanen, S. P., Komar, G., Seppänen, M. P., Dean, K. I., Minn, H. R., Kajander, S. A., Rinta-Kiikka, I., Alanen, K., Borra, R. J., Puolakkainen, P. A., Nuutila, P., & Ovaska, J. T. (2009). A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Annals of Surgery, 250(6), 957-63. https://doi.org/10.1097/SLA.0b013e3181b2fafa
Kauhanen SP, et al. A Prospective Diagnostic Accuracy Study of 18F-fluorodeoxyglucose Positron Emission Tomography/computed Tomography, Multidetector Row Computed Tomography, and Magnetic Resonance Imaging in Primary Diagnosis and Staging of Pancreatic Cancer. Ann Surg. 2009;250(6):957-63. PubMed PMID: 19687736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. AU - Kauhanen,Saila P, AU - Komar,Gaber, AU - Seppänen,Marko P, AU - Dean,Kirsti I, AU - Minn,Heikki R, AU - Kajander,Sami A, AU - Rinta-Kiikka,Irina, AU - Alanen,Kalle, AU - Borra,Ronald J, AU - Puolakkainen,Pauli A, AU - Nuutila,Pirjo, AU - Ovaska,Jari T, PY - 2009/8/19/entrez PY - 2009/8/19/pubmed PY - 2010/1/6/medline SP - 957 EP - 63 JF - Annals of surgery JO - Ann Surg VL - 250 IS - 6 N2 - OBJECTIVE: To prospectively compare the accuracy of combined positron emission tomography/computed tomography using F-fluorodeoxyglucose (FDG-PET/CT), multidetector row computed tomography (MDCT), and magnetic resonance imaging (MRI) in the evaluation of patients with suspected pancreatic malignancy. SUMMARY BACKGROUND DATA: FDG-PET/CT imaging is increasingly used for staging of pancreatic cancer. Preliminary data suggest a significant influence of FDG-PET/CT on treatment planning, although its role is still evolving. METHODS: Thirty-eight consecutive patients with suspicion of pancreatic malignancy were enrolled. Patients underwent a protocol including FDG-PET/CT, MDCT, and MRI combined with magnetic resonance cholangiopancreatography, all of which were blindly evaluated. The findings were confirmed macroscopically at operation and/or by histopathologic analysis (n = 29) or follow-up (n = 9). Results of TNM classification of different imaging methods were compared with clinical TNM classification. RESULTS: Pancreatic adenocarcinoma was diagnosed in 17 patients, neuroendocrine tumor in 3, mass-forming pancreatitis in 4, cystic lesion in 6, and fibrosis in 2. Six patients had a finding of a normal pancreas. The diagnostic accuracy of FDG-PET/CT for pancreatic malignancy was 89%, compared with 76% and 79% for MDCT and MRI, respectively. In the differential diagnosis of suspected malignant biliary stricture at endoscopic retrograde cholangiopancreaticography (n = 21), FDG-PET/CT had a positive predictive value of 92%. In 17 patients with advanced pancreatic adenocarcinoma, FDG-PET/CT had a sensitivity of 30% for N- and 88% for M-staging. Both MDCT and MRI had sensitivities of 30% for N- and 38% for M-staging. Furthermore, the clinical management of 10 patients (26%) was altered after FDG-PET/CT. CONCLUSION: FDG-PET/CT was more sensitive than conventional imaging in the diagnosis of both primary pancreatic adenocarcinoma and associated distant metastases. In contrast, the sensitivity of FDG-PET/CT was poor in detecting local lymph node metastasis, which would have been important for an assessment of resectability. We recommend the use of FDG-PET/CT in the evaluation of diagnostically challenging cases, especially in patients with biliary strictures without evidence of malignancy in conventional imaging. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19687736/A_prospective_diagnostic_accuracy_study_of_18F_fluorodeoxyglucose_positron_emission_tomography/computed_tomography_multidetector_row_computed_tomography_and_magnetic_resonance_imaging_in_primary_diagnosis_and_staging_of_pancreatic_cancer_ L2 - https://Insights.ovid.com/pubmed?pmid=19687736 DB - PRIME DP - Unbound Medicine ER -