Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary-mucinous neoplasm of the pancreas

Abstract

Abstract. Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas presents in various histopathological stages from benign to malignant lesions. The differentiation between benign and malignant IPMN is important in order t o determine the treatment of the patients. However, preoperative differentiation remains difficult. The aim of this study was to assess the utility of 2-[18 F] fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET) in preoperative differentiation of benign and malignant IPMN of the pancreas. In the present study we prospectively investigated 29 patients who underwent CT, FDG-PET, and surgery for IPMNs, followed by histopathological examination. The maximum standardized uptake value (SUVmax) was determined on FDG-PET, and differentiation of benign from malignant IPMN was tested using various SUVmax cut-off levels and various parameters derived from the CT. SUVmax was found to be significantly higher in malignant IPMNs (4.7±3.0) than that in benign IPMNs (1.8±0.3, P=0.0011). SUVmax values correlated with the histopathological types of IPMN (adenoma/borderline lesion/carcinoma in situ/invasive carcinoma) (Spearman rank correlation 0.865, P<0.0001). The specificity, sensitivity and accuracy values were best for SUVmax of 2.5 (100, 93, and 96%, respectively). The combination of mural nodule, detected on CT, and SUVmax of 2.5 offered the best diagnosis of malignant IPMN. These results suggest that FDG-PET is useful for differentiation of malignant IPMN of the pancreas, and that it should be performed in combination with other conventional imaging modalities.

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.…”

“…The SUV max cut-offs used in the different studies to differentiate benign from malignant lesions ranged from 1.3 to 3.0, with a mean value of 2.3. Several authors [15,16,18,19,24] used a SUV max of 2.5 as the cut-off for malignancy on the strength of previous reports in the literature. Takanami et al [17] adopted a value of 2.3, based on a receiver operating characteristic curve (ROC) analysis in the cohort study balancing the sensitivity and specificity of different cut-offs.…”

“…Hong et al [15] identified as malignant a lesion with any of the following features: main duct type, marked dilation of the MPD (≥10 mm), large mural nodules (≥1 cm), large cyst size (≥3 cm), irregular or septate cyst, calcifications, or patulous duodenal papilla. Tomimaru et al [16] analyzed different radiological aspects (cyst size ≥3 cm, dilation of MPD ≥7 mm, presence/absence of mural nodules); in their series, the presence of mural nodules was the most accurate indicator (86%) of malignancy, regardless of their size. 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.…”

Comparison of Preoperative Imaging Modalities for the Assessment of Malignant Potential of Pancreatic Cystic Lesions

“…A total of 1018 patients (1019 lesions) from 17 direct comparison studies using 2 or more preoperative imaging modalities were included for differentiating malignant from benign PCL or IPMN. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Of 17 studies, 4 were performed in a prospective manner. 27,30,34,35 The mean age of the patients was 63.2 years, and 43.8% (446/1019) of the lesions were found to be malignant by surgery, biopsy, or clinical follow-up.…”

The role of 18F-fluorodeoxyglucose positron emission tomography in the management of patients with pancreatic adenocarcinoma

“…The largest study assessing the reliability 18 F-FDG-PET in this clinical scenario was by Sperti et al [31] who demonstrated in their cohort of 64 patients with suspected IPMNs that 18 F-FDG-PET had a greater sensitivity (92 versus 58 %), specificity (97 versus 82 %), and accuracy (95 versus 72 %) than conventional imaging. Another study by Tomimaru et al [32] reported on 29 patients who underwent CT, 18 F-FDG-PET, and surgery for IPMNs, followed by histopathological examination. They found that the SUVmax on 18 F-FDG-PET correlated with the histopathological types of IPMN (benign adenoma, carcinoma in situ, or invasive carcinoma).…”