Significance of fluorodeoxyglucose PET imaging in the diagnosis of malignancies in patients with biliary stricture

Wakabayashi, Hisao; Akamoto, Shintaro; Yachida, Shinichi; Okano, Keiichi; Izuishi, Kunihiko; Nishiyama, Yoshihiro; Maeta, Hajime

doi:10.1016/j.ejso.2005.05.012

Cited by 60 publications

(34 citation statements)

References 14 publications

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“…Therefore, radiological findings and, in some cases, surgical interventions should be used in additiontoCA19-9assessmentforanaccuratediagnosis.AlthoughextremelyhighCA19-9levels,togetherwithclinical andradiologicalfindingsmayimplicateamalignancy,thisis notalwaystrue,aswehaveshowninourcase.PETwith[ 18 F] FDGhasbeensuccessfullyusedfordiagnosticevaluationof cholangiocarcinomas, and is associated with a sensitivity of 92% and a specificity of 93% [10]. However, inflammatory processesmaycauseincreasedFDGuptakeincertaincases, causingfalse-positiveresults.Thus,FDG-PETimagingmust beinterpretedcarefully,especiallyinpatientswithsclerosing cholangitis, biliary stents, or other benign inflammatory conditionssuchascholecystitis [11,12].Andersonetal. [11] reported that in 1 of 7 patients with sclerosing cholangitis in their series, FDG-PET imaging was falsely interpreted as indicatingmalignantdisease.Klugeetal.…”

Section: Discussionmentioning

confidence: 99%

Biliary Obstruction Induces Extremely Elevated Serum CA 19-9 Levels: Case Report

Onal

Çolakoğlu²,

Ulusan³

et al. 2012

Onkologie

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Background: Assessment of carbohydrate antigen (CA) 19-9 levels is used for diagnosis and follow-up of pancreaticobiliary cancers, and high levels of this biomarker are suggestive of a malignancy. CA 19-9 may also be elevated in patients with conditions other than tumors, such as cholestasis, biliary obstruction, and cholecystitis. Case Report: A 50-year-old male patient presented with jaundice and elevated CA 19-9 levels (161,902 IU/ml). Repeated biopsies of the common bile duct revealed no malignancies. Radiological findings indicated a mass protruding through the common bile duct. Positron emission tomography demonstrated increased ¹⁸F-fluoro2-deoxy-D-glucose uptake in the liver and a mass resembling metastasis was detected. A Whipple procedure was performed and demonstrated no tumor. Postoperatively, CA 19-9 levels decreased to within normal limits (27 IU/ml). Conclusion: These results indicate that CA 19-9 levels should not be the sole criterion for a diagnosis of malignancy. Although other analytical tools may aid diagnosis, surgical exploration may be required in some instances to avoid misdiagnosis and determine whether radiological results are falsely positive.

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Section: Discussionmentioning

confidence: 99%

Biliary Obstruction Induces Extremely Elevated Serum CA 19-9 Levels: Case Report

Onal

Çolakoğlu²,

Ulusan³

et al. 2012

Onkologie

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“…PET and PET/CT are proven to be useful in the diagnosis and staging of CC. In a recent study, PET showed sensitivity and specificity of 90% and 78% respectively [148] . In another study by Anderson et al [149] , PET had sensitivity of 85% for CC measuring at least 1 cm in size although its sensitivity was only 18% for infiltrating CC.…”

Section: Positron Emission Tomography (Pet)mentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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“…In one series, PET led to a change of therapeutic management in 30% of patients suffering from cholangiocarcinoma because of detection of primary unsuspected metastases [26] . The limitation of FDG-PET is false positive results in patients with biliary tract infections, primary sclerosing cholangitis, and biliary stenting via endoscopic retrograde cholangiography (ERC) and PTBD [26,31] . The diagnostic sensitivity can be increased by using 18-fluorodeoxyglucose (FDG) in combination with CT scanning (FDG-PET/CT).…”

Section: Positron Emission Tomography (Pet)mentioning

confidence: 99%

Diagnostic approaches for cholangiocarcinoma

Weber

Schmid²,

Prinz³

2008

WJG

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Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fineneedle aspiration. In the future, new techniques allowing for early detection, including molecular m a r ke r s , s h o u l d b e d e ve l o p e d t o i m p rove t h e diagnostic sensitivity in this increasing tumor entity.

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Significance of fluorodeoxyglucose PET imaging in the diagnosis of malignancies in patients with biliary stricture

Cited by 60 publications

References 14 publications

Biliary Obstruction Induces Extremely Elevated Serum CA 19-9 Levels: Case Report

Biliary Obstruction Induces Extremely Elevated Serum CA 19-9 Levels: Case Report

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Diagnostic approaches for cholangiocarcinoma

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