Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 29, Issue 8, pp 1047-1054

First online:

Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

  • Takashi KatoAffiliated withDepartment of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 6, Kita-ku, Sapporo 060-8638, Japan
  • , Eriko TsukamotoAffiliated withDepartment of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 6, Kita-ku, Sapporo 060-8638, Japan
  • , Yuji KugeAffiliated withDepartment of Tracer Kinetics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Chietsugu KatohAffiliated withDepartment of Tracer Kinetics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Toshikazu NambuAffiliated withDepartment of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Aichiro NobutaAffiliated withDepartment of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Satoshi KondoAffiliated withDivision of Cancer Medicine, Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Masahiro AsakaAffiliated withDepartment of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • , Nagara TamakiAffiliated withDepartment of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 6, Kita-ku, Sapporo 060-8638, Japan

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Abstract.

In extrahepatic bile duct cancer, preoperative evaluation is important because only surgical excision of all detectable tumours is associated with improvement in 5-year survival. However, morphological imaging techniques, including computed tomography (CT), are still insufficient for accurate staging. The purpose of this study was to assess the additional value, in relation to CT, of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) for the evaluation of extrahepatic bile duct cancer. Thirty patients with extrahepatic bile duct cancer underwent both 18F-FDG PET and CT for initial staging. The results of the two modalities for evaluation of primary tumours and regional lymph nodes were compared with the final diagnoses based on pathological or clinical findings. The primary tumours were interpreted as malignant on the basis of CT in 24 (80%) of the patients, while 18F-FDG PET revealed increased 18F-FDG uptake in 18 (60%) of them. On the other hand, 18F-FDG PET showed focal accumulation of 18F-FDG in the bile duct in three of the six patients with equivocal findings on CT. The sensitivity, specificity and accuracy of CT for regional lymph node metastases were 54%, 59% and 57%, while those of 18F-FDG PET were 38%, 100% and 73%, respectively. The specificity of 18F-FDG PET for regional lymph node metastases was significantly higher than that of CT (P<0.01). Of 14 patients with N1 or N2 disease diagnosed by CT, only seven (50%) had a final diagnosis of regional lymph node metastasis. In these 14 patients, 18F-FDG PET accurately evaluated the N component of the disease in 12 patients (86%). In conclusion, in the initial staging of patients with extrahepatic bile duct cancer, 18F-FDG PET offers additional value in relation to CT in evaluating both the primary tumour and regional lymph nodes.

Bile duct cancer FDG Positron emission tomography Computed tomography