Diagnostic impact of 18F-FDG PET–CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound

Schick, Verena; Franzius, Christiane; Beyna, Tors﻿ten; Oei, May Lin; Schnekenburger, Jürgen; Weckesser, Matthias; Domschke, Wolfram; Schober, Otmar; Heindel, Walter; Pohle, Thorsten; Juergens, Kai Uwe

doi:10.1007/s00259-008-0818-x

Cited by 71 publications

(53 citation statements)

References 45 publications

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“…in benign lesions of 4.2 ± 1.5. 51 Another study demonstrated an average SUV max. for malignant lesions of 6.72 ± 3.84 and an average SUV max.…”

Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 98%

“…A definitive cut-off value is difficult to define for pancreatic malignancies and therefore qualitative data should also be included in clinical studies such as FDG tracer uptake patterns. 51,52 The use of contrast-enhanced PET/CT may represent a complete diagnostic staging procedure without the need for separate MDCT. One study found that contrast-enhanced FDG-PET/CT was superior to FDG-PET (p = 0.035) and there was a trend (p = 0.07) for contrast-enhanced FDG PET/CT to be superior to unenhanced PET/CT 53 in assessing resectability.…”

Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 99%

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PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

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“…in benign lesions of 4.2 ± 1.5. 51 Another study demonstrated an average SUV max. for malignant lesions of 6.72 ± 3.84 and an average SUV max.…”

Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 98%

Section: Positron Emission Tomography/computed Tomography In Pancreatmentioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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“…The current literature includes relatively little data regarding the diagnostic role of PET/CT in patients with periampullary tumors (16)(17)(18)(19). Although the FDG-sensitivity of tumors originating from the pancreas has been reported to be between 88% and 92% (17,(19)(20)(21)(22)(23)(24)(25), there are limited findings for tumors that originate from the ampulla or distal choledochus (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers have emphasized that ampullary tumors less than 1 cm in diameter may not have any SUV max on PET/CT (15,16,18,21). In the ampulla group, PET/ CT observable SUV max was higher for tumors with diameters greater than 2 cm (15, 22, 25* In several studies of ampullary tumors, PET/CT SUV max was higher for tumors with diameters greater than 2 cm (15,22,25) In the present study, we also found an association between tumor size and differentiation.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG activitiy PET/CT and CA-19.9 levels for the prediction of histopathological features and localization of peri- ampullary tumors

Akçam

Ülkü²,

Rencüzoğulları³

et al. 2015

Turk J Gastroenterol

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Background/Aims: We sought to investigate the roles of maximum standardized uptake value (SUV max ) and serum carbohydrate antigen in predicting the histopathological features of periampullary tumors. Materials and Methods: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUV max was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUV max and CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors. Results: 18F-FDG PET/CT SUV max (<2.5 vs. ≥2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUV max were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter. Conclusion: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUV max and CA 19-9 levels.

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“…The degree of 18 F-FDG uptake is directly proportional to lesion size, particularly with most lesions larger than 1 cm. Measuring standardized uptake values (SUVs) for tumors smaller than 1 cm is fraught with errors because of partial-volume averaging (6).…”

Section: Pet/ct Application In Initial Management Of Pancreatic Maligmentioning

confidence: 99%

PET/CT for Pancreatic Malignancy: Potential and Pitfalls

Jha

Bijan

2015

Journal of Nuclear Medicine Technology

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Pancreatic malignancy carries a poor prognosis and is the fourth leading cause of cancer-related deaths in the United States. Although conventional imaging with CT and MR remains the main imaging modality, recent times have seen an increase in the applications of PET/CT in the evaluation of pancreatic malignancy. Newer data are becoming available, highlighting the advantages, limitations, and pitfalls in PET/CT imaging of the pancreas. This article highlights the applications of PET/CT in various stages of management of pancreatic malignancy and compares these with conventional imaging with CT and MR.

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Diagnostic impact of 18F-FDG PET–CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound

Abstract: (18)F-FDG PET-CT achieves a comparably high diagnostic impact evaluating small solid pancreatic lesions versus conventional reference imaging modalities. Additional clinical diagnoses are derived from concomitant whole-body PET-CT imaging.

Cited by 71 publications

References 45 publications

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

18F-FDG activitiy PET/CT and CA-19.9 levels for the prediction of histopathological features and localization of peri- ampullary tumors

PET/CT for Pancreatic Malignancy: Potential and Pitfalls

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