Ann Surg Treat Res.  2022 Jun;102(6):335-341. 10.4174/astr.2022.102.6.335.

Diagnostic and prognostic impact of fluorodeoxyglucosepositron emission tomography in diagnosing intraductal papillary neoplasms of the bile duct of the liver

• Choi JU
• Hwang S
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Kim JS
• Hong SM

• KMID: 2530388
• DOI: http://doi.org/10.4174/astr.2022.102.6.335

Abstract

Purpose
Malignant intraductal papillary neoplasm of the bile duct of the liver (IPNB-L) cannot readily be diagnosed through preoperative CT or MRI, but fluorodeoxyglucose (FDG)-PET is a viable alternative. This study evaluated the diagnostic and prognostic impacts of FDG-PET in patients with IPNB-L.
Methods
This was a retrospective single-center study of 101 IPNB-L patients who underwent hepatectomy between 2010 and 2019.
Results
Mean age was 64.4 ± 8.3 years and 76 (75.2%) were male. Anatomical hepatic resection was performed in 99 (98.0%). Concurrent bile duct resection and pancreaticoduodenectomy were performed in 41 (40.6%) and 1 (1.0%), respectively. R0 and R1 resections were performed in 88 (87.1%) and 13 (12.9%), respectively. Low-grade intraepithelial neoplasia and high-grade neoplasia/invasive carcinoma were diagnosed in 19 (18.8%) and 82 (81.2%), respectively. Median FDG-PET maximal standardized uptake values (SUVmax) in low-grade neoplasia and high-grade neoplasia/carcinoma were 3.6 (range, 1.7–7.6) and 5.2 (range, 1.5–18.7) (P = 0.019), respectively. Receiver operating characteristic curve analysis of SUVmax showed area under the curve of 0.674, with sensitivity of 84.2% and specificity of 47.4% at SUVmax cutoff of 3.0. This cutoff had no significant influence on tumor recurrence (P = 0.832) or patient survival (P = 0.996) in patients with IPNB-L of high-grade neoplasia or invasive carcinoma.
Conclusion
IPNB-L is a rare type of biliary neoplasm and encompasses a histological spectrum ranging from benign disease to invasive carcinoma. An FDG-PET SUVmax cutoff of 3.0 appears to effectively discern high-grade neoplasia/ carcinoma from low-grade neoplasia, which will assist with the surgical strategy for these cases.

Keyword

Carcinoma; Dysplasia; Imaging study; Malignant transformation; Papillary growth

Figure

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  Fig. 1 Comparison of tumor recurrence (A) and overall patient survival (B) curves according to the histological tumor grade. IPNB-L, intraductal papillary neoplasm of the bile duct of the liver.

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  Fig. 2 Distribution of fluorodeoxyglucose-PET maximal standardized uptake values (SUVmax) according to the histological tumor grade. IPNB-L, intraductal papillary neoplasm of the bile duct of the liver.

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  Fig. 3 Receiver operating characteristic curve analysis for predicting intraductal papillary neoplasms of the bile duct of the liver with high-grade intraepithelial neoplasia and invasive carcinoma.

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  Fig. 4 Validation using precision-recall curve analysis matched with receiver operating characteristic curve analysis for intraductal papillary neoplasms of the bile duct of the liver with high-grade intraepithelial neoplasia and invasive carcinoma. PPV, positive predictive value.

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  Fig. 5 Comparison of tumor recurrence (A) and overall patient survival (B) curves according to a fluorodeoxyglucose-PET maximal standardized uptake value (SUVmax) cutoff of 3.0 in patients with intraductal papillary neoplasms of the bile duct of the liver with high-grade intraepithelial neoplasia and invasive carcinoma.

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