Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-<scp>d</scp>-glucose for the differentiation of chronic pancreatitis and pancreatic cancer

Imdahl, A.; Nitzsche, Egbert U.; Krautmann, F.; Högerle, S.; Boos, S.; Einert, Almut; Sontheimer, J.; Farthmann, E. H.

doi:10.1046/j.1365-2168.1999.01016.x

Cited by 127 publications

(42 citation statements)

References 18 publications

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“…Current image and laboratory tests have improved the diagnostic efficiency to some extent, but insufficiently. Recently, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer, and is reported to be a valuable diagnostic modality for differentiating malignant from benign lesions of the pancreas 1,2,3,4,5,6,7 . Therefore, many patients who are suspected of having pancreatic cancer tend to undergo FDG-PET, which is necessary to differentiate between pancreatic cancer and benign pancreatic conditions such as tumor-forming chronic pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

et al. 2008

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Purposes: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods: We compared the FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results: FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. The accumulation pattern of nodular shape was frequently seen in pancreatic cancer with significance, whereas a longitudinal shape indicated the existence of autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Most cases of pancreatic cancer showed solitary localization with significant difference, whereas multiple localizations in the pancreas favored the existence of autoimmune pancreatitis. FDG uptakes in the hilar lymph node were more frequently seen in autoimmune pancreatitis than in pancreatic cancer with significance, and those in the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were only seen in autoimmune pancreatitis. Conclusions: FDG-PET provides a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if its accumulation pattern and extra-pancreatic involvements are considered. IgG4 measurement and other current image tests will confirm further diagnosis.

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Section: Introductionmentioning

confidence: 99%

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

et al. 2008

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“…Previously published series involving 18-FDG PET in the evaluation of pancreatic adenocarcinoma reported a sensitivity ranging from 82% to 100% and a specificity of 67% to 100%. [25][26][27] Rose et al 19 reported a sensitivity of 92% and a specificity of 85% in detecting pancreatic cancer for 18-FDG PET versus 65% and 62% for CT scanning. However, the role of 18-FDG PET in the evaluation of pancreatic cystic tumors has not been previously investigated.…”

Section: Discussionmentioning

confidence: 99%

Value of 18-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients With Cystic Tumors of the Pancreas

Sperti¹,

Pasquali²,

Chierichetti³

et al. 2001

Annals of Surgery

113

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ObjectiveTo assess the reliability of 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) in distinguishing benign from malignant cystic lesions of the pancreas. Summary Background DataThe preoperative differential diagnosis of cystic lesions of the pancreas remains difficult: the most important point is to identify malignant or premalignant cysts that require resection. 18-FDG PET is a new imaging procedure based on the increased glucose metabolism by tumor cells and has been proposed for the diagnosis and staging of pancreatic cancer. MethodsDuring a 4-year period, 56 patients with a suspected cystic tumor of the pancreas underwent 18-FDG PET in addition to computed tomography scanning, serum CA 19-9 assay, and in some instances magnetic resonance imaging or endoscopic retrograde cholangiopancreatography. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value. The accuracy of 18-FDG PET and computed tomography was determined for preoperative diagnosis of a malignant cyst. ResultsSeventeen patients had malignant tumors. Sixteen patients (94%) showed 18-FDG uptake with a standard uptake value of 2.6 to 12.0. Twelve patients (70%) were correctly identified as having malignancy by computed tomography, CA 19-9 assay, or both. Thirty-nine patients had benign tumors: only one mucinous cystadenoma showed increased 18-FDG uptake (standard uptake value 2.6). Five patients with benign cysts showed computed tomography findings of malignancy. Sensitivity, specificity, and positive and negative predictive values for 18-FDG PET and computed tomography scanning in detecting malignant tumors were 94%, 97%, 94%, and 97% and 65%, 87%, 69%, and 85%, respectively. Conclusions18-FDG PET is more accurate than computed tomography in identifying malignant pancreatic cystic lesions and should be used, in combination with computed tomography and tumor markers assay, in the preoperative evaluation of patients with pancreatic cystic lesions. A positive result on 18-FDG PET strongly suggests malignancy and, therefore, a need for resection; a negative result shows a benign tumor that may be treated with limited resection or, in selected high-risk patients, with biopsy, follow-up, or both.

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“…More detailed analysis of FDG uptake during PET by semi-quantitative techniques may be more accurate for diagnosis, cut-off values have always been calculated retrospectively without prospective evaluation and there is a wide variation in the diagnostic threshold values (table 4) [20, 21, 23, 24, 26, 27, 37]. Indeed it is recognised that a standardised uptake ratio threshold for the differentiation between chronic pancreatitis and pancreatic cancer does not exist [37].…”

Section: Discussionmentioning

confidence: 99%

“…Initial reports that FDG PET was of diagnostic value [21,22,23, 35] were further supported [24,25,26,27,36,37,38,39] to the extent that a consensus conference in Germany concluded that FDG PET had achieved an established clinical role in the diagnosis and staging of pancreatic cancer [40]. More recent studies have however failed to demonstrate any advantage for FDG PET compared to CT [28, 29, 31, 41, 42].…”

Section: Introductionmentioning

confidence: 99%

“…There are limitations however in the diagnosis of small tumours, detection of lymph node metastases and other intra-abdominal metastatic lesions, as well as in the ability of CT to distinguish between pancreatic malignancy and chronic pancreatitis [15,16,17,18,19]. During the last decade, 18 F-fluoro-2-deoxy- D -glucose (FDG) positron emission tomography (PET) that uses neoplastic metabolism as the basis for differential tracer uptake has been evaluated as a diagnostic and staging tool in pancreatic cancer [20,21,22,23,24,25,26,27,28,29,30,31,32]. FDG is a positron-emitting radio-tracer that is transported intracellularly via glucose transporters which are highly expressed in pancreatic cancer, then FDG is phosphorylated by hexokinase to FDG-6-PO 4 [33, 34].…”

Section: Introductionmentioning

confidence: 99%

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Positron Emission Tomography Does Not Add to Computed Tomography for the Diagnosis and Staging of Pancreatic Cancer

Lytras¹,

Connor²,

Bosonnet³

et al. 2005

Dig Surg

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Background: Positron emission tomography (PET) has been proposed for pancreatic cancer diagnosis and staging. Methods: 112 patients with suspected pancreatic cancer underwent ¹⁸F-fluoro-2-deoxy-D-glucose gamma camera PET and computed tomography (CT), of whom 62 also had laparoscopic ultrasonography and 70 underwent abdominal exploration for potential resection. The final diagnosis was malignancy in 78 and benign disease in 34 patients (25 with chronic pancreatitis). Results: The diagnostic sensitivity and specificity for PET were 73 and 60% compared to 89 and 65% for CT respectively (Cohen’s ĸ = 0.59). In 30 patients CT was equivocal with cancer in 14 and benign disease in 16. PET correctly diagnosed 13 of these patients (cancer in 6 and benign disease in 7), interpreted 4 as equivocal (cancer in 3 and benign disease in 1) but was incorrect in the remaining 13 patients (cancer in 5 and benign disease in 8). The sensitivity and specificity for detecting small volume metastatic disease were 20 and 94% for CT and 22 and 91% for PET, respectively. Conclusion: PET had a similar accuracy to that of CT for imaging pancreatic cancer but it did not provide any additional information in patients with equivocal CT findings and currently would seem of little benefit for the staging of pancreatic cancer.

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Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-d-glucose for the differentiation of chronic pancreatitis and pancreatic cancer

Cited by 127 publications

References 18 publications

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

Value of 18-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients With Cystic Tumors of the Pancreas

Positron Emission Tomography Does Not Add to Computed Tomography for the Diagnosis and Staging of Pancreatic Cancer

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