Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology

Abstract

The aim of this study was to evaluate the value of positron emission tomography with (18)F-labeled fluorodeoxyglucose (FDG-PET) as a preoperative diagnostic investigation in patients with biliary carcinoma. Seventy-two patients with potentially resectable biliary carcinoma underwent preoperative multidetector-row computed tomography (MDCT) and FDG-PET. Both diagnoses were compared with subsequent histopathology and follow-up results. In 64 lesions with biliary carcinoma, 57 (89%) revealed an intense focal accumulation on FDG-PET and were interpreted as malignant. On the other hand, eight benign lesions did not show any specific accumulation. Detection rate of FDG-PET in the nodular type of the tumour (96% or 27/28) was superior to that of the infiltrating type (74% or 17/23) (p = 0.037). For the evaluation of lymph node metastasis, the overall accuracy was 69% (35/51) in both FDG-PET and MDCT: FDG-PET had a lower sensitivity (33% vs. 57%) and a higher specificity (97% vs. 79%) than MDCT, although the values were not significantly different. FDG-PET revealed all six lesions of distant metastases in six patients including two lesions missed by MDCT. FDG-PET has high detectability of biliary malignancies. Like MDCT, FDG-PET offers only modest accuracy for regional lymph node staging, but it may reveal distant metastases missed by MDCT.

The role of PET scans in the management of Cholangiocarcinoma and Gallbladder Cancer: A systematic review for surgeons

“…The literature search yielded 12 papers [6][7][8][9][10][11][12][13][14][15][16][17] for inclusion in the study as outlined in the PRISMA statement of search results (see Figure 1). The study characteristics for all included papers are summarised in Table 1 and the results as they pertain to the four clinical questions driving this review are summarized in Table 2.…”

“…The study characteristics for all included papers are summarised in Table 1 and the results as they pertain to the four clinical questions driving this review are summarized in Table 2. [6] 2009 32 Pro GBC SQ Corvera [7] 2008 126 Retro GBC/CC (Intrahepatic/ Extrahepatic) SQ Furukawa [8] 2008 72 Retro GBC/ CC (Extrahepatic) Visual Kim [9] 2008 123 Pro CC (Intrahepatic/ Extrahepatic/ Hilar) SQ/ Visual Kitajima [10] 2009 50 Retro GBC/CC Visual Kumar [11] 2012 49 Retro GBC Visual Lee [13] 2010 99 Retro CC (Intrahepatic/ Extrahepatic SQ/ Visual Lee [12] 2011 50 Retro GBC/CC (Intrahepatic/ Extrahepatic SQ/ Visual…”

“…Retro: Retrospective; Pro: Prospective; CC: Cholangiocarcinoma; GB: Gallbladder carcinoma; SQ: Semi-quantitative Table 2. Summary of study findings Question Butte [6] Corvera [7] Furukawa [8] Kim [9] Kitajima [10] Kumar [11] How effective is PET-CT in defining regional lymph node metastases CCA [12] Li [14] Ruys [15] Seo [16] Shukla [17] How …”

“…Seven studies examined the role of PET-CT in gallbladder carcinoma [7,8,10,12,17,18] though two studies [8,10] did not report their results specifically. Butte et al [6] investigated 32 patients with incidental gallbladder carcinoma following laparoscopic cholecystectomy.…”

“…There were nine studies [7][8][9][10][12][13][14][15][16] which evaluated the role of PET-CT in cholangiocarcinoma. Two studies reported their results as 'biliary' cancer with no further detail [8,13] .…”