Usefulness of 18-FDG PET/CT in Detecting Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

Abstract

Background/Aim: Identifying malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas remains challenging. This study aimed to evaluate the usefulness of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT) in distinguishing malignant from benign IPMN of the pancreas. Patients and Methods: The cases of 79 patients with IPMN of the pancreas who underwent surgical resections between 1996 and 2016 at our Institution were enrolled in the present retrospective analysis of predictors for malignancy in IPMN of the pancreas. 18-FDG PET/CT evaluations were performed in 38 patients, and the usefulness of 18-FDG PET/CT for detecting malignancy in IPMN of the pancreas was evaluated. Results: Three factors were significantly related to malignancy in IPMN; the diameter of the main pancreatic duct, the serum value of carcinoembryonic antigen (CEA), and the neutrophil-to-lymphocyte ratio (NLR). 18-FDG PET accumulation was significantly related to malignancy in IPMN; sensitivity 0.82 and specificity 0.71. Independent predictors for malignancy in IPMN were as follows: 18-FDG PET accumulation, CEA >1.0 ng/ml, and NLR >2.63. Conclusion: 18-FDG PET accumulation is a potent new marker for distinguishing malignant from benign IPMNs of the pancreas.

The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…Overall, 986 records were identified. After screening the titles and abstracts according to our inclusion and exclusion criteria, 100 full-text articles were assessed for eligibility and 10 studies [15][16][17][18][19][20][21][22][23][24] were ultimately included in our critical appraisal ( Figure 1). Patients' data were collected and analyzed on the basis of their radiological or metabolic diagnostic findings.…”

“…Roch et al [21] considered as malignant any lesion with a SUV max higher than 3. Yamashita et al [23] defined as malignant a focal uptake of radiotracer with a SUV max ≥1.3. Ohta et al [22] did not specify a SUV max cut-off, but considered IPMNs as malignant if they had a greater metabolic uptake than the remnant gland.…”

“…Takanami et al [17] and Saito et al [20] Cancers 2020, 12, 807 5 of 11 respectively identified a dilation of the MPD >5 mm and ≥7 mm as the most accurate radiological criterion of malignancy. Other authors [18,19,21,22,24] classified malignant IPMN according to ICG criteria [6,7], while Yamashita et al [23] chose MPD ≥10 mm as the cut-off for distinguishing between benign and malignant lesions after performing a ROC analysis. The ICG criteria identified 152 TP, 108 TN, 78 FP, and 74 FN in all, resulting in a sensitivity, specificity, and accuracy of 67.3% (60.9-73.0), 58.1% (50.9-64.9), and 63.1% (58.4-67.8), respectively.…”

Serum N‐Glycome analysis reveals pancreatic cancer disease signatures

“…[5][6][7][8][9] However, screening programs based on current detection methods that comprise imaging techniques and/or fine-needle-aspirations, are not feasible. 10,11 Moreover, chronic and autoimmune pancreatitis (CP) can mimic PDAC and consequently cause a 5%-10% misclassification. 12 For these reasons, new bloodbased biomarker tests are pursued that offer a more cost-effective way to detect the disease.…”

“…It is furthermore noted that the number of PDAC deaths is not far from that of, for example, breast cancer, and a future screening for PDAC may be warranted 5‐9 . However, screening programs based on current detection methods that comprise imaging techniques and/or fine‐needle‐aspirations, are not feasible 10,11 . Moreover, chronic and autoimmune pancreatitis (CP) can mimic PDAC and consequently cause a 5%‐10% misclassification 12 .…”