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

Abstract

AIM:To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment. METHODS:This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer. RESULTS:The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.CONCLUSION: FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.

Prognostic stratification using F-18 FDG PET/CT in patients with advanced stage (Stage III and IV) non-small cell lung cancer

“…However, these tumor response evaluations based on anatomical changes before and after treatment had several weak points. F-18 FDG PET/CT has emerged as a significant molecular imaging technique in clinical oncology and cancer research [13][14][15]. Tumor response evaluation by F-18 FDG PET and PET/CT appears to be more sensitive and accurate because F-18 FDG PET is able to assess viable tumor cells.…”

Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma

“…However, local vascular involvement, nodal and distant metastases are frequently found at the time of diagnosis, thus losing the opportunity of operation [3] . At present, the best way for preoperative staging of pancreatic cancer is boluscontrast, and triple-phase helical computed tomography, which has been shown to be almost 100% accurate in predicting unresectable disease [4][5][6] . However, approximately 25%-50% of patients with resectable disease on computed tomography are found to have unresectable lesions at laparotomy [7] .…”

The Pathogenesis, Diagnosis, and Management of Pancreatic Cancer

“…Anatomical and functional imaging can be obtained simultaneously using PET-CT. However, current guidelines do not support routine PET in the work-up of pancreatic cancer [63].…”