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

Farma, Jeffrey M.; Santillan, Alfredo A.; Melis, Marcovalerio; Walters, Janet L.; Belinc, Daly; Chen, Dung-Tsa; Eikman, Edward A.; Malafa, Mokenge P.

doi:10.1245/s10434-008-9992-0

Cited by 165 publications

(93 citation statements)

References 19 publications

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“…Another study demonstrated that the sensitivity and specificity of FDG-PET/CT was 88% and 89%, respectively, in patients being assessed for pancreatic cancer and changed the management of six (11%) patients. 47 These patients were found to have extrapancreatic disease that prevented them from undergoing pancreatic resection. Another study assessed two groups of patients, a diagnosis and staging group and a screening group, for progressive or recurrent disease.…”

Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 99%

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PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 99%

“…44,[46][47][48]78,79,84 The effect size with regard to change in management ranges from 41% to 10%. 44,[46][47][48]78,79,84 The largest study was a retrospective series of 285 patients over a period of 7 years. The addition of PET/CT changed management in 31 (10%) patients.…”

Section: Additional Analysesmentioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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“…Pancreatic cancer has mostly metastasized to liver and peritoneal cavities, supraclavicular lymph nodes have rarely affected with pancreatic cancer (24). Prevalance of supraclavicular metastasis from pancreas cancer was 1.9% -2.4% (23,24). There have isolated rare case reports regarding pancreatic cancer and supraclavicular lymph node metastasis (23,24).…”

Section: Discussionmentioning

confidence: 97%

“…For supraclavicular metastasis of urothelial cancer, there were no reported cases for curative neck dissection in the literature. Pancreatic cancer was the fourth common cancer related death in both men and women (23). Pancreatic cancer has mostly metastasized to liver and peritoneal cavities, supraclavicular lymph nodes have rarely affected with pancreatic cancer (24).…”

Section: Discussionmentioning

confidence: 99%

Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients

et al. 2017

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Background: Supraclavicular fossa masses have usually been malignant lesions. When fine needle aspiration biopsy results have not been satisfactory excisional biopsy of supraclavicular lymphadenopathy would be mandatory. Methods:In this study we investigated 18 patients who had supraclavicular region metastasis from infraclavicular primary sites. Results: Distant metastatic sites were mostly lung in origin. Other sites were breast, prostate, pancreas, cervix, urothelial, gastric carcinoma and pleural mesothelioma. All of our patients except the one with mesothelioma have died within one year after diagnosis of supraclavicular metastasis due to disseminated disease.Conclusions: Supraclavicular neck masses should be evaluated carefully, since they were mostly malignant in origin. Lung has been the most common origin site. Early diagnosis would be critical because supraclavicular metastasis indicates poor prognosis with decreased survival. Excisional biopsy should be performed promptly when fine needle aspiration biopsy was not diagnostic.

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“…Other imaging modalities, such as positron emission tomography-computed tomography, have been shown to provide a complimentary role to MDCT and MRCP in the detection of extra-abdominal metastases [17]. Thus, they may play a crucial role in the preoperative work-up of locally advanced cancers, since the treatment options would sharply vary based on the positron emission tomography scan findings.…”

Section: Radiologymentioning

confidence: 99%

Surgery for Pancreatic Carcinoma: State of the Art

Shrikhande

Barreto

2011

Indian J Surg

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Carcinoma of the pancreas remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. To date, surgery affords the best outcomes when a complete resection can be achieved. Improvements in imaging, surgical techniques and adjuvant therapies are perceived advancements in the management of this cancer. This article reviews the latest evidence in terms of the diagnosis and management of pancreatic cancer.

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

Cited by 165 publications

References 19 publications

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients

Surgery for Pancreatic Carcinoma: State of the Art

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