BACKGROUND: The role of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) scanning in operable pancreas cancer is unclear. We, therefore, wanted to investigate the impact of PET/CT on management, by incorporating it into routine work-up. METHODS: This was a single-institution prospective study. Patients with suspected and potentially operable pancreas, distal bile duct or ampullary carcinomas underwent PET/CT in addition to routine work-up. The frequency that PET/CT changed the treatment plan or prompted other investigations was determined. The distribution of standard uptake values (SUV) among primary tumours, and adjacent to biliary stents was characterised. RESULTS: Fifty-six patients were recruited. The surgical plan was abandoned in 9 (16%; 95% CI: 6-26) patients as a result of PET/CT identified metastases. In four patients, metastases were missed and seven were inoperable at surgery, not predicted by PET/CT. Unexpected FDG uptake resulted in seven additional investigations, of which two were useful. Among primary pancreatic cancers, a median SUV was 4.9 (range 2-12.1). SUV was highest around the biliary stent in 17 out of 28 cases. PET/CT detected metastases in five patients whose primary pancreatic tumours demonstrated mild to moderate avidity (SUV < 5). CONCLUSIONS: PET/CT in potentially operable pancreas cancer has limitations. However, as a result of its ability to detect metastases, PET/CT scanning is a useful tool in the selection of such patients for surgery.
BACKGROUND: The role of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) scanning in operable pancreas cancer is unclear. We, therefore, wanted to investigate the impact of PET/CT on management, by incorporating it into routine work-up. METHODS: This was a single-institution prospective study. Patients with suspected and potentially operable pancreas, distal bile duct or ampullary carcinomas underwent PET/CT in addition to routine work-up. The frequency that PET/CT changed the treatment plan or prompted other investigations was determined. The distribution of standard uptake values (SUV) among primary tumours, and adjacent to biliary stents was characterised. RESULTS: Fifty-six patients were recruited. The surgical plan was abandoned in 9 (16%; 95% CI: 6-26) patients as a result of PET/CT identified metastases. In four patients, metastases were missed and seven were inoperable at surgery, not predicted by PET/CT. Unexpected FDG uptake resulted in seven additional investigations, of which two were useful. Among primary pancreatic cancers, a median SUV was 4.9 (range 2-12.1). SUV was highest around the biliary stent in 17 out of 28 cases. PET/CT detected metastases in five patients whose primary pancreatic tumours demonstrated mild to moderate avidity (SUV < 5). CONCLUSIONS: PET/CT in potentially operable pancreas cancer has limitations. However, as a result of its ability to detect metastases, PET/CT scanning is a useful tool in the selection of such patients for surgery.
Authors: Helmut Oettle; Stefan Post; Peter Neuhaus; Klaus Gellert; Jan Langrehr; Karsten Ridwelski; Harald Schramm; Joerg Fahlke; Carl Zuelke; Christof Burkart; Klaus Gutberlet; Erika Kettner; Harald Schmalenberg; Karin Weigang-Koehler; Wolf-Otto Bechstein; Marco Niedergethmann; Ingo Schmidt-Wolf; Lars Roll; Bernd Doerken; Hanno Riess Journal: JAMA Date: 2007-01-17 Impact factor: 56.272
Authors: Stefan Heinrich; Gerhard W Goerres; Markus Schäfer; Markus Sagmeister; Peter Bauerfeind; Bernhard C Pestalozzi; Thomas F Hany; Gustav K von Schulthess; Pierre-Alain Clavien Journal: Ann Surg Date: 2005-08 Impact factor: 12.969
Authors: P Flamen; A Lerut; E Van Cutsem; W De Wever; M Peeters; S Stroobants; P Dupont; G Bormans; M Hiele; P De Leyn; D Van Raemdonck; W Coosemans; N Ectors; K Haustermans; L Mortelmans Journal: J Clin Oncol Date: 2000-09-15 Impact factor: 44.544
Authors: John P Neoptolemos; Deborah D Stocken; Claudio Bassi; Paula Ghaneh; David Cunningham; David Goldstein; Robert Padbury; Malcolm J Moore; Steven Gallinger; Christophe Mariette; Moritz N Wente; Jakob R Izbicki; Helmut Friess; Markus M Lerch; Christos Dervenis; Attila Oláh; Giovanni Butturini; Ryuichiro Doi; Pehr A Lind; David Smith; Juan W Valle; Daniel H Palmer; John A Buckels; Joyce Thompson; Colin J McKay; Charlotte L Rawcliffe; Markus W Büchler Journal: JAMA Date: 2010-09-08 Impact factor: 56.272
Authors: Saila P Kauhanen; Gaber Komar; Marko P Seppänen; Kirsti I Dean; Heikki R Minn; Sami A Kajander; Irina Rinta-Kiikka; Kalle Alanen; Ronald J Borra; Pauli A Puolakkainen; Pirjo Nuutila; Jari T Ovaska Journal: Ann Surg Date: 2009-12 Impact factor: 12.969
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069