Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases

Zimny, M.; Bares, Roland; Faß, J.; Adam, Gerhard; Cremerius, U.; Dohmen, Bernhard M.; Klever, P.; Sabri, Osama; Schumpelick, Volker; Buell, Udalrich

doi:10.1007/s002590050106

Cited by 58 publications

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“…The utility of semiquantitative interpretation of 18 FDG-PET in the diagnosis of pancreatic cancer has been debated in the literature. Zimny et al 31 reported that visual interpretation of the images was superior to the use of the SUR. Conversely, Inokuma et al 29 and Stollfuss et al 26 found the two techniques of interpretation to be comparable.…”

Section: Discussionmentioning

confidence: 99%

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

et al. 1999

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ObjectiveTo assess the accuracy and clinical impact of 18 fluorodeoxyglucose-positron emission tomography ( 18 FDG-PET) on the management of patients with suspected primary or recurrent pancreatic adenocarcinoma, and to assess the utility of 18 FDG-PET in grading tumor response to neoadjuvant chemoradiation. Summary Background DataThe diagnosis, staging, and treatment of pancreatic cancer remain difficult. Small primary tumors and hepatic metastases are often not well visualized by computed tomographic scanning (CT), resulting in a high incidence of nontherapeutic celiotomy and the frequent need for "blind resection." In addition, the distinction between local recurrence and nonspecific postoperative changes after resection can be difficult to ascertain on standard anatomic imaging. 18FDG-PET is a new imaging technique that takes advantage of increased glucose metabolism by tumor cells and may improve the diagnostic accuracy of preoperative studies for pancreatic adenocarcinoma. Methods Eighty-one18 FDG-PET scans were obtained in 70 patients undergoing evaluation for suspected primary or recurrent pancreatic adenocarcinoma. Of this group, 65 underwent evaluation for suspected primary pancreatic cancer. Nine patients underwent 18 FDG-PET imaging before and after neoadjuvant chemoradiation, and in eight patients 18 FDG-PET scans were performed for possible recurrent adenocarcinoma after resection. The 18 FDG-PET images were analyzed visually and semiquantitatively using the standard uptake ratio (SUR). The sensitivity and specificity of 18 FDG-PET and CT were determined for evaluation of the preoperative diagnosis of primary pancreatic carcinoma, and the impact of 18 FDG-PET on patient management was retrospectively assessed. ResultsAmong the 65 patients evaluated for primary tumor, 52 had proven pancreatic adenocarcinoma and 13 had benign lesions.18 FDG-PET had a higher sensitivity and specificity than CT in correctly diagnosing pancreatic carcinoma (92% and 85% vs. 65% and 62%). Eighteen patients (28%) had indeterminate or unrecognized pancreatic masses on CT clarified with 18 FDG-PET. Seven patients (11%) had indeterminate or unrecognized metastatic disease clarified with 18 FDG-PET. Overall, 18FDG-PET suggested potential alterations in clinical management in 28/65 patients (43%) with suspected primary pancreatic adenocarcinoma. Of the nine patients undergoing 18 FDG-PET imaging before and after neoadjuvant chemoradiation, four had evidence of tumor regression by PET, three showed stable disease, and two showed tumor progression. CT was unable to detect any response to neoadjuvant therapy in this group. Eight patients had 18 FDG-PET scans to evaluate suspected recurrent disease after resection. Four were noted to have new regions of 18 FDG-uptake in the resection bed; four had evidence of new hepatic metastases. All proved to have metastatic pancreatic adenocarcinoma. ConclusionsThese data confirm that 18 FDG-PET is useful in the evaluation of patients with suspected primary or recurrent pancreatic carcinoma.18...

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Section: Discussionmentioning

confidence: 99%

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

et al. 1999

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“…This phenomenon, known as the Warburg effect, is observed in PDAC and many other tumor types (Zimny et al 1997;Boros et al 2002;Ying et al 2012). Elevated glucose uptake by tumor cells has stimulated studies to exploit this process for therapeutic purposes.…”

Section: Kras-dependent Glucose Metabolism Reprogrammingmentioning

confidence: 99%

Genetics and biology of pancreatic ductal adenocarcinoma

et al. 2016

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With 5-year survival rates remaining constant at 6% and rising incidences associated with an epidemic in obesity and metabolic syndrome, pancreatic ductal adenocarcinoma (PDAC) is on track to become the second most common cause of cancer-related deaths by 2030. The high mortality rate of PDAC stems primarily from the lack of early diagnosis and ineffective treatment for advanced tumors. During the past decade, the comprehensive atlas of genomic alterations, the prominence of specific pathways, the preclinical validation of such emerging targets, sophisticated preclinical model systems, and the molecular classification of PDAC into specific disease subtypes have all converged to illuminate drug discovery programs with clearer clinical path hypotheses. A deeper understanding of cancer cell biology, particularly altered cancer cell metabolism and impaired DNA repair processes, is providing novel therapeutic strategies that show strong preclinical activity. Elucidation of tumor biology principles, most notably a deeper understanding of the complexity of immune regulation in the tumor microenvironment, has provided an exciting framework to reawaken the immune system to attack PDAC cancer cells. While the long road of translation lies ahead, the path to meaningful clinical progress has never been clearer to improve PDAC patient survival. Pancreatic ductal adenocarcinoma (PDAC) pathogenesisOn gross inspection, PDAC presents as a poorly demarcated, firm white-yellow mass, with the surrounding nonmalignant pancreas typically showing atrophy, fibrosis, and dilated ducts due to the obstructive effects of expanding carcinoma. Microscopically, these neoplasms vary from well-differentiated gland-forming carcinomas to poorly differentiated "sarcomatoid" carcinomas diagnosed only upon immunolabeling due to predominant mesenchymal features (Hruban et al. 2007). PDAC evolves from well-defined precursor lesions that, in the context of their genetic features, define the genetic progression model of pancreatic carcinogenesis (Yachida et al. 2010). Early disease histology manifests as several distinct types of precursor lesions-the most common are microscopic pancreatic intraepithelial neoplasia (PanIN), followed by the macroscopic cysts; namely, the intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) (Matthaei et al. 2011). Since most PDAC cases become clinically apparent at advanced stages, major opportunities to reduce mortality rest with diagnostics and treatments that would enable the reliable identification and elimination of high-risk precursor lesions. Thus, the identification of these precursor lesions has provided an essential framework to define the genomic features that drive progression to advanced disease and develop effective screening and targeted therapeutics for earlier stage disease (Eser et al. 2011).The noninvasive PanIN lesions were formerly classified into three grades according to the extent of cytological and architectural atypia: PanIN1A (flat lesion) and PanIN1B (micropapillary...

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“…Current image and laboratory tests have improved the diagnostic efficiency to some extent, but insufficiently. Recently, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer, and is reported to be a valuable diagnostic modality for differentiating malignant from benign lesions of the pancreas 1,2,3,4,5,6,7 . Therefore, many patients who are suspected of having pancreatic cancer tend to undergo FDG-PET, which is necessary to differentiate between pancreatic cancer and benign pancreatic conditions such as tumor-forming chronic pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

et al. 2008

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Purposes: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods: We compared the FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results: FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. The accumulation pattern of nodular shape was frequently seen in pancreatic cancer with significance, whereas a longitudinal shape indicated the existence of autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Most cases of pancreatic cancer showed solitary localization with significant difference, whereas multiple localizations in the pancreas favored the existence of autoimmune pancreatitis. FDG uptakes in the hilar lymph node were more frequently seen in autoimmune pancreatitis than in pancreatic cancer with significance, and those in the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were only seen in autoimmune pancreatitis. Conclusions: FDG-PET provides a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if its accumulation pattern and extra-pancreatic involvements are considered. IgG4 measurement and other current image tests will confirm further diagnosis.

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Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases

Cited by 58 publications

References 0 publications

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

18Fluorodeoxyglucose-Positron Emission Tomography in the Management of Patients With Suspected Pancreatic Cancer

Genetics and biology of pancreatic ductal adenocarcinoma

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

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