Performance of Integrated FDG-PET/Contrast-enhanced CT in the Diagnosis of Recurrent Pancreatic Cancer: Comparison with Integrated FDG-PET/Non-contrast-enhanced CT and Enhanced CT

Kitajima, Kazuhiro; Murakami, Koji; Yamasaki, Erena; Kaji, Yuichi; Shimoda, Mitsugi; Kubota, Keiichi; Suganuma, Narufumi; Sugimura, Kazuro

doi:10.1007/s11307-009-0271-7

Cited by 58 publications

(28 citation statements)

References 23 publications

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“…These data are further confirmed by Kitajima and colleagues in a series of studies in patients with uterine, ovarian, colorectal and pancreas cancer [8][9][10][11][12][13].…”

Section: Contrast-enhanced Studies With Pet/ct Hybrid Camerassupporting

confidence: 65%

Hybrid versus fusion imaging: are we moving forward judiciously?

Giovanella

Lucignani

2010

Eur J Nucl Med Mol Imaging

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“…These data are further confirmed by Kitajima and colleagues in a series of studies in patients with uterine, ovarian, colorectal and pancreas cancer [8][9][10][11][12][13].…”

Section: Contrast-enhanced Studies With Pet/ct Hybrid Camerassupporting

confidence: 65%

Hybrid versus fusion imaging: are we moving forward judiciously?

Giovanella

Lucignani

2010

Eur J Nucl Med Mol Imaging

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“…However, false-positive FDG-PET findings may be seen in inflammatory conditions, while hyperglycemia and small tumor sizes may results in false-negative results. In addition, most of the lymph node metastasis remains undetectable because of their small size, for which a low sensitivity range between 20%-35% was observed [36,44]. Clearly, the capability of FDG-PET/CT in detecting subclinical disease in lymph node is limited, and the use of the results of FDG-PET/CT to guide CTV-node delineation is not feasible at this time.…”

Section: Discussionmentioning

confidence: 99%

Proposing the lymphatic target volume for elective radiation therapy for pancreatic cancer: a pooled analysis of clinical evidence

et al. 2010

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BackgroundRadiation therapy is an important cancer treatment modality in both adjuvant and definitive setting, however, the use of radiation therapy for elective treatment of regional lymph nodes is controversial for pancreatic cancer. No consensus on proper selection and delineation of subclinical lymph nodal areas in adjuvant or definitive radiation therapy has been suggested either conclusively or proposed for further investigation. This analysis aims to study the pattern of lymph node metastasis through a pooled analysis of published results after radical tumor and lymph nodal resection with histological study in pancreatic cancer.MethodsLiterature search using electronic databases including MEDLINE, EMBASE, and CANCERLIT from January 1970 to June 2009 was performed, supplemented by review of references. Eighteen original researches and a total of 5954 pancreatic cancer patients underwent radical surgical resection were included in this analysis. The probability of metastasis in regional lymph nodal stations (using Japan Pancreas Society [JPS] Classification) was calculated and analyzed based on the location and other characteristics of the primary disease.ResultsCommonly involved nodal regions in patients with pancreatic head tumor include lymph nodes around the common hepatic artery (Group 8, 9.79%), posterior pancreaticoduodenal lymph nodes (Group 13, 32.31%), lymph nodes around the superior mesenteric artery (Group 14, 15.85%), paraaortic lymph nodes (Group 16, 10.92%), and anterior pancreaticoduodenal lymph nodes (Group 17, 19.78%); The probability of metastasis in other lymph nodal regions were <9%.Commonly involved nodal regions in patients with pancreatic body/tail tumor include lymph nodes around the common hepatic artery (Group 8, 15.07%), lymph nodes around the celiac trunk (Group 9, 9.59%), lymph nodes along the splenic artery (Group 11, 35.62%), lymph nodes around the superior mesenteric artery (Group 14, 9.59%), paraaortic lymph nodes (Group 16, 16.44%), and inferior body lymph nodes (Group 18, 24.66%). The probability of metastasis in other lymph nodal regions were <9%.ConclusionsPancreatic cancer has a high propensity of regional lymphatic metastases; however, clear patterns including the site and probability of metastasis can be identified and used as a guide of treatment in patients with resectable pancreatic cancer. Further clinical investigation is needed to study the efficacy of elective treatment to CTV defined based on these patterns using high-dose conformal or intensity-modulated radiation therapy.

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“…10 articles were excluded after reviewing the full article: (i) the aim of the articles was not to reveal the diagnostic value of DWI or PET/CT for identification and characterization of malignant pancreatic malignancy; 16,17 (ii) researchers in the articles did not have enough data that could be used to construct or calculate true-positive, falsepositive, true-negative, and false-negative results; [18][19][20] (iii) study was not published in English; 21,22 (iv) results presented in the article were from a combination of many diagnostic methods to detect pancreatic malignancy that could not be differentiated for assessment of single test; 23 and (v) there were articles of which there were less than 10 patients. 24,25 A total of 16 studies [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] with 804 patients, which fulfilled all of the inclusion criteria, were considered for the analysis. The characteristics of the 16 studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Of all 16 studies, 10 studies 28,[30][31][32][33][34][36][37][38]41 enrolled patients prospectively, five studies 27,29,35,39,40 enrolled patients retrospectively, and one study 26 was unknown. Eight studies 27,28,[30][31][32][33][34][35] enrolled patients in a consecutive manner; the others 26,29,[36][37][38][39][40][41] were not in a consecutive manner or unknown. There were nine studies 26,27,29,31,[33][34][35][36][37]40 in which the MRI or PET/CT reviewer was blinded to other test results and clinical data.…”

Section: Study Design Characteristicsmentioning

confidence: 99%

“…In all studies, imaging data were presented about the identification of patients; the reference standard was histopathologic analysis and clinical follow‐up. Of all 16 studies, 10 studies 28,30–34,36–38,41 enrolled patients prospectively, five studies 27,29,35,39,40 enrolled patients retrospectively, and one study 26 was unknown. Eight studies 27,28,30–35 enrolled patients in a consecutive manner; the others 26,29,36–41 were not in a consecutive manner or unknown.…”

mentioning

confidence: 99%

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Diagnostic value of diffusion‐weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: A meta‐analysis using a hierarchical regression model

Wu¹,

Hu²,

Liu³

et al. 2012

J of Gastro and Hepatol

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Background and Aim: To obtain diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pancreatic malignancy. Methods: We performed a meta-analysis of all available studies of the diagnostic performance of DWI and PET/CT for pancreatic malignancy. MEDLINE, EMBASE, Cochrane library and some other databases were searched for initial studies. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves (SROC) using hierarchical regression models. Results: Across 16 studies with 804 patients, PET/CT sensitivity was 0.87 (95% confidence interval [CI], 0.82, 0.81) and specificity was 0.83 (95% CI, 0.71, 0.91). Overall, LR+ was 5.84 (95% CI, 4.59, 7.42) and LR-was 0.24 (95% CI, 0.17, 0.33). DWI sensitivity was 0.85 (95% CI, 0.74, 0.92) and specificity was 0.91 (95% CI, 0.71, 0.98). LR+ was 9.53 (95% CI, 2.41, 37.65) and LR-was 0.17 (95% CI, 0.09, 0.32). In subgroup analysis, the sensitivity of enhanced versus unenhanced PET/CT in the detection of pancreatic cancer was 0.91 (95% CI, 0.86, 0.96) versus 0.84 (95% CI, 0.78, 0.90) (P > 0.05), the specificity 0.88 (95% CI, 0.73, 1.00) versus 0.81 (95% CI, 0.69, 0.94) (P > 0.05). Conclusion: Positron emission tomography/computed tomography (PET/CT) was highly sensitive and DWI was a highly specific modality in diagnosing patients with pancreatic malignancy. PET/CT and DWI could play different roles in diagnosing pancreatic carcinoma. Enhanced PET/CT seems to be superior to unenhanced PET/CT. Further larger prospective studies are needed to establish its value for diagnosis in pancreatic cancer.

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Performance of Integrated FDG-PET/Contrast-enhanced CT in the Diagnosis of Recurrent Pancreatic Cancer: Comparison with Integrated FDG-PET/Non-contrast-enhanced CT and Enhanced CT

Abstract: PET/contrast-enhanced CT is an accurate modality for assessing recurrence of pancreatic cancer.

Cited by 58 publications

References 23 publications

Hybrid versus fusion imaging: are we moving forward judiciously?

Hybrid versus fusion imaging: are we moving forward judiciously?

Proposing the lymphatic target volume for elective radiation therapy for pancreatic cancer: a pooled analysis of clinical evidence

Diagnostic value of diffusion‐weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: A meta‐analysis using a hierarchical regression model

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