Korean J Gastroenterol.  2009 Oct;54(4):235-242. 10.4166/kjg.2009.54.4.235.

Diagnostic Usefulness of PET/CT for Pancreatic Malignancy

• Park SS
• Lee KT
• Lee KH
• Lee JK
• Kim SH
• Choi JY
• Rhee JC

• KMID: 783229
• DOI: http://doi.org/10.4166/kjg.2009.54.4.235

Abstract

BACKGROUND/AIMS
The purpose of this study was to evaluate the diagnostic usefulness of PET/CT for pancreatic malignancy.
METHODS
We retrospectively analyzed medical records of 115 patients with pathologically diagnosed pancreatic cancer between January 2003 to August 2008 who underwent abdominal CT and PET/CT examination before histological confirmation. CT and PET/CT images were reviewed in single-blinded status and diagnostic ability on primary pancreatic lesion, regional lymph node metastasis, and distant metastasis was evaluated.
RESULTS
99 patients (86%) had malignant diseases including 91 cases of adenocarcinoma, and 16 patients (14%) benign diseases. Only CA 19-9 value and SUV were significantly different between PET/CT positive and negative groups (p=0.001, p<0.001). Sensitivity, specificity and positive predictive values (PPV) of both modality for pancreatic lesion were same (94%, 62%, and 95%, respectively), and negative predictive values (NPV) were 67% on CT and 57% on PET/CT. PET/CT correctly diagnosed 8 cases (6.9%) of falsely diagnosed pancreatic lesion on CT. Nine cases (15.7%) of misdiagnosed lymph node metastasis on CT were correctly diagnosed on PET/CT. But, there was no significant difference in the diagnosis of regional lymph node metastasis. 3 out of 29 cases of distant metastasis, except 2 cases of supraclavicular lymph node metastasis, were additionally diagnosed by PET/CT. But, overall sensitivity of distant metastasis was significantly higher in CT (83% vs 69%, p=0.045).
CONCLUSIONS
Although PET/CT provided additional correct diagnoses in many cases, it showed fair diagnostic power for primary pancreatic lesion and lymph node metastasis, and lower sensitivity for distant metastasis. Therefore, PET/CT should be used as an supplementary modality of CT in diagnosing pancreatic malignancy.

Keyword

PET/CT; Pancreatic neoplasm

MeSH Terms

Adult
Aged
Aged, 80 and over
CA-19-9 Antigen/analysis
Diagnostic Errors
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Pancreatic Neoplasms/*diagnosis/pathology
*Positron-Emission Tomography
Retrospective Studies
*Tomography, X-Ray Computed

Reference

1. Kim CY. Digestive disease. 2nd ed.Reston: Iljogak;2005. 1007-1023.

2. Tann M, Sandrasegaran K, Jennings SG, Skandarajah A, McHenry L, Schmidt CM. Positron-emission tomography and computed tomography of cystic pancreatic masses. Clin Radiol. 2007; 62:745–751.

3. Yun M. Roles of F-18 FDG PET or PET/CT for the evaluation of gastrointestinal malignancies. Korean J Gastroenterol. 2006; 48:378–387.

4. Sendler A, Avril N, Helmberger H, et al. Preoperative evaluation of pancreatic masses with positron emission tomography using 18F-fluorodeoxyglucose: diagnostic limitations. World J Surg. 2000; 24:1121–1129.

5. Rose DM, Delbeke D, Beauchamp RD, et al. 18Fluorodeoxy-glucose-positron emission tomography in the management of patients with suspected pancreatic cancer. Ann Surg. 1999; 229:729–737.

6. Friess H, Langhans J, Ebert M, et al. Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography. Gut. 1995; 36:771–777.

7. Orlando LA, Kulasingam SL, Matchar DB. Meta-analysis: the detection of pancreatic malignancy with positron emission tomography. Aliment Pharmacol Ther. 2004; 20:1063–1070.

8. Heinrich S, Goerres GW, Schafer M, et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg. 2005; 242:235–243.

9. Ruf J, Lopez Hanninen E, Oettle H, et al. Detection of recurrent pancreatic cancer: comparison of FDG-PET with CT/MRI. Pancreatology. 2005; 5:266–272.

10. Lemke AJ, Niehues SM, Hosten N, et al. Retrospective digital image fusion of multidetector CT and 18F-FDG PET: clinical value in pancreatic lesions–a prospective study with 104 patients. J Nucl Med. 2004; 45:1279–1286.

11. Catalano C, Laghi A, Fraioli F, et al. Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability. Eur Radiol. 2003; 13:149–156.

12. Mansour JC, Schwartz L, Pandit-Taskar N, et al. The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas. J Gastrointest Surg. 2006; 10:1354–1360.

13. Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer. Best Pract Res Clin Gastroenterol. 2006; 20:227–251.

14. Diederichs CG, Staib L, Glatting G, Beger HG, Reske SN. FDG PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 1998; 39:1030–1033.

15. Zimny M, Bares R, Fass J, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med. 1997; 24:678–682.

16. Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer–a PET study. J Nucl Med. 1993; 34:1–6.

17. Koyama K, Okamura T, Kawabe J, et al. Diagnostic usefulness of FDG PET for pancreatic mass lesions. Ann Nucl Med. 2001; 15:217–224.

18. Berberat P, Friess H, Kashiwagi M, Beger HG, Buchler MW. Diagnosis and staging of pancreatic cancer by positron emission tomography. World J Surg. 1999; 23:882–887.

19. Stollfuss JC, Glatting G, Friess H, Kocher F, Berger HG, Reske SN. 2-(fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology. 1995; 195:339–344.

20. Bares R, Klever P, Hauptmann S, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology. 1994; 192:79–86.

21. Reisser C, Haberkorn U, Strauss LG. The relevance of positron emission tomography for the diagnosis and treatment of head and neck tumors. J Otolaryngol. 1993; 22:231–238.

22. Yun M, Lim JS, Noh SH, et al. Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT. J Nucl Med. 2005; 46:1582–1588.

23. Saif MW, Cornfeld D, Modarresifar H, Ojha B. 18F-FDG positron emission tomography CT (FDG PET-CT) in the management of pancreatic cancer: initial experience in 12 patients. J Gastrointestin Liver Dis. 2008; 17:173–178.

24. Antoch G, Freudenberg LS, Stattaus J, et al. Whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. AJR Am J Roentgenol. 2002; 179:1555–1560.

25. Antoch G, Freudenberg LS, Egelhof T, et al. Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans. J Nucl Med. 2002; 43:1339–1342.

26. Messa C, Bettinardi V, Picchio M, et al. PET/CT in diagnostic oncology. Q J Nucl Med Mol Imaging. 2004; 48:66–75.