Comparison of Preoperative Imaging Modalities for the Assessment of Malignant Potential of Pancreatic Cystic Lesions

Abstract

The aims of this study are to compare the performance of various preoperative imaging modalities for assessing the malignant potential of pancreatic cystic lesions (PCLs) through a network meta-analysis (NMA) and to clarify the role of 18 F-FDG PET in the management of patients with PCL. Methods: PubMed, EMBASE, and Cochrane Library were searched for the studies evaluating the performance of preoperative imaging modalities for identifying malignant PCLs. The NMA was performed for 4 representative categories of various imaging modalities in terms of diagnostic performance for differentiating malignant from benign PCL and intraductal papillary mucinous neoplasms only as a subgroup analysis. To calculate the probability of each imaging modality being the most effective diagnostic method, the surface under the cumulative ranking curve values were obtained. Results: A total of 1018 patients from 17 direct comparison studies using 2 or more preoperative imaging modalities were included for differentiating malignant from benign PCL. The positive predictive value (PPV) and accuracy of 18 F-FDG PET were significantly higher than that of CT (PPV: odds ratio [

Principais exames complementares analisados em pacientes com câncer de pâncreas

“…Além disso, há ainda o PET/CT, uma técnica que utiliza a tomografia por emissão de pósitrons (PET) adjunta a tomografía computarizada convencional para diagnosticar e diferenciar tumores primários e detectar metástases (LIU et al, 2023). O PET/CT utilizado com flúor-18-fluorodesoxiglicose (18 F-FDG) é um traçado utilizado para avaliação sistemática pré-operatória que, apesar do seu alto custo, sugere maior modalidade em diferenciação de câncer de pâncreas malígnos e benígnos (LIU et al, 2023;LEE et al, 2022). O F-FDG PET mostrou maior eficiência em questão de sensibilidade e especificidade na diferenciação de câncer de pâncreas maligno e benigno seguido por ressonância magnética ou tomografia computadorizada (LEE et al, 2022).…”

“…O PET/CT utilizado com flúor-18-fluorodesoxiglicose (18 F-FDG) é um traçado utilizado para avaliação sistemática pré-operatória que, apesar do seu alto custo, sugere maior modalidade em diferenciação de câncer de pâncreas malígnos e benígnos (LIU et al, 2023;LEE et al, 2022). O F-FDG PET mostrou maior eficiência em questão de sensibilidade e especificidade na diferenciação de câncer de pâncreas maligno e benigno seguido por ressonância magnética ou tomografia computadorizada (LEE et al, 2022). A figura 1 apresenta um fluxograma resumindo as características distintivas dos tipos de exames de imagem utilizados para a avaliação do câncer de pâncreas.…”

Pancreatic Cystic Neoplasms: Translating Guidelines into Clinical Practice

“…However, it is important to know that, although 18-FDG PET or PET/CT is noninvasive, without a risk of radiation exposure, 18-FDG is not specific to the tumor cells and has the potential to accumulate in inflammatory cells, resulting in false-positive findings. A network meta-analysis including 1018 patients from 17 direct comparison studies (8 studies used F18-FDG PET or PET/CT) showed that the positive predictive value and accuracy of F18 FDG PET in differentiating malignant from benign PCLs were significantly higher than CT or MRI in all PCLs, including IPMNs [42]. Therefore, F18-FDG PET or PET/CT may complement the Fukuoka guidelines for the preoperative management of PCLs.…”

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

“…Additionally, MRI assessment of cyst fluid together with other signs may predict the malignant transformation of IPMNs [58], assisted by three dimensional (3D)-MRCP [59] or 3T MRI [60]. It has been postulated that 18 F-Fluorodeoxyglucose ( 18 FDG)-PET is the best imaging tool for malignant cystic lesions [61]. A screening system using forward viewing radial EUS and MRI/MRCP for screening individuals with a family history of pancreatic cancer has been proposed [62].…”