Positron Emission Tomography Does Not Add to Computed Tomography for the Diagnosis and Staging of Pancreatic Cancer

Abstract

Background: Positron emission tomography (PET) has been proposed for pancreatic cancer diagnosis and staging. Methods: 112 patients with suspected pancreatic cancer underwent ¹⁸F-fluoro-2-deoxy-D-glucose gamma camera PET and computed tomography (CT), of whom 62 also had laparoscopic ultrasonography and 70 underwent abdominal exploration for potential resection. The final diagnosis was malignancy in 78 and benign disease in 34 patients (25 with chronic pancreatitis). Results: The diagnostic sensitivity and specificity for PET were 73 and 60% compared to 89 and 65% for CT respectively (Cohen’s ĸ = 0.59). In 30 patients CT was equivocal with cancer in 14 and benign disease in 16. PET correctly diagnosed 13 of these patients (cancer in 6 and benign disease in 7), interpreted 4 as equivocal (cancer in 3 and benign disease in 1) but was incorrect in the remaining 13 patients (cancer in 5 and benign disease in 8). The sensitivity and specificity for detecting small volume metastatic disease were 20 and 94% for CT and 22 and 91% for PET, respectively. Conclusion: PET had a similar accuracy to that of CT for imaging pancreatic cancer but it did not provide any additional information in patients with equivocal CT findings and currently would seem of little benefit for the staging 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

“…Pancreatic cancer is associated with a marked desmoplastic response and stromal inflammatory cells in and around the neoplasm may be responsible for the uptake of FDG. In the study by Lytras et al, 40 10 of the 12 patients with false-positive results had chronic pancreatitis. Orlando et al 24 conducted one of the first meta-analyses to compare FDG-PET with CT in studies of patients with pancreatic cancer.…”

“…Prostate, pancreatic and ovarian cancers represented 30% of cases. The post-PET plan was 39 One of the larger studies assessed the role of FDG-PET in 112 patients with suspected pancreatic cancer 40 and demonstrated a sensitivity and specificity for FDG-PET of 73% and 60% and for CT of 89% and 65%. FDG-PET had a similar accuracy to CT but did not provide any additional information in patients with equivocal CT findings.…”

Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer

“…Our findings also correlate with those of previous reports, in which the sensitivity of FDG-PET, CT, and US has been reported to be 94%, 89%, and 89%, respectively [12] . On the other hand, in another study, the sensitivity of FDG-PET was found to be lower than or equal to CT [13][14][15] and these findings thus remain controversial. In particular, when a multidetector CT is performed routinely with thin sections (1 mm), the sensitivity of the CT may further improve [2] .…”

Cancers du pancréas exocrine

“…En raison d'une spécificité relativement faible de l'échographie transabdominale et d'un champ d'exploration relativement limité de l'échoendoscopie, la TDM et l'IRM sont actuellement les techniques recommandées pour la réalisation de ce bilan. L'association de la TEP à la TDM offre une alternative séduisante combinant les diagnostics anatomique et métabolique, dont les résultats publiés sont cependant contradictoires d'une série à l'autre [25][26][27] , appelant à des analyses sur de plus larges séries. …”