Early recurrence detected by 18F-FDG PET/CT in patients with resected pancreatic ductal adenocarcinoma

Abstract

18 F-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography ( 18 F-FDG PET/CT) has been proved to be practical in detecting occult malignant lesions. However, the evidence of its utility in detecting early recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) is lacking. Therefore, the primary aim of the present study is to evaluate the diagnostic value of 18 F-FDG PET/CT in the early postoperative period after radical resection of PDAC. This retrospective study included 32 patients who had 18 F-FDG PET/CT scan within 6 months after radical resection of PDAC between January 2010 and December 2018. In total, 10 positive PET results were found at surgical margins of remnant pancreas, 12 at locoregional lymph nodes, 5 at distant areas, with the corresponding mean maximum standard uptake value (SUV max ) of 5.8 ± 1.1, 5.9 ± 0.9, and 6.4 ± 0.7, respectively. The median follow-up time was 23.5 months (range: 8–75 months), and the median survival time was 39.5 months (95% confidence interval: 14.6–64.4 months) for the entire cohort. Patients with positive PET findings at either locoregional lymph nodes or distant areas obtained significantly poorer overall survival (OS) than those without increased FDG uptake at the corresponding areas ( P = .003 and P < .001, respectively). Whereas comparisons of OS between patients with or without increased FDG uptake at the surgical margin of remnant pancreas presented no statistically difference ( P = .742). The early application of 18 F-FDG PET/CT after radical resection of PDAC could stratify the prognosis of patients well by detecting occult early recurrence at locoregional lymph nodes and distant areas efficiently.

Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

“…In addition, research shows that changes in the levels of CA19-9 are frequently more than 6 mo earlier than radiological recurrence in patients with pancreatic cancer[ 64 ]. In addition, PET-CT represents a more sensitive approach compared with the traditional imaging methods (CT and magnetic resonance imaging [MRI]), and it is also used for the early detection of tumor recurrence after pancreatic cancer surgery[ 65 , 66 ]. Six (100%) cases receiving PET showed that the seeding tumors increased the uptake of fluorodeoxyglucose.…”

Prognostic Implications of 18-FDG Positron Emission Tomography/Computed Tomography in Resectable Pancreatic Cancer

“…There is evidence of 18-FDG uptake in malignant tumors being related to a tumor’s aggressiveness. Some authors [ 19 , 20 , 21 ] have reported on prognostic information obtained with 18-FDG-PET in patients with pancreatic cancer, or outlined the role of PET in predicting early recurrences after surgery [ 22 , 23 , 24 ]. The numbers of patients included in these studies were too small to draw any final conclusions, however.…”