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Tumors of the Liver and Biliary Tract

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Nuclear Oncology

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Abstract

Hepatoma or hepatocellular carcinoma (HCC), a tumor arising from hepatocytes, is one of the most common tumors worldwide, with approximately one million new cases diagnosed/year. Five-year survival ranges from 70% for stage I to <20% for stage III. HCC is often associated with cirrhosis and chronic hepatitis. The tumor is staged using the AJCC TNM classification, which considers tumor size, vascular invasion, lymph node status, and metastatic disease. The tumor is usually advanced at the time of diagnosis. CT and MRI are usually used for staging used for this purpose. Several reports indicated low sensitivity of [18F]FDG for detecting HCC due to a relatively low [18F]FDG uptake within the tumor, due to the presence of glucose-6-phosphatase (G-6-Pase), an enzyme present in normal liver, which converts [18F]FDG-6-P to [18F]FDG, allowing the tracer to diffuse out of tumor cells. [18F]FDG-PET has clinical value for identifying distant metastases and identifying poorly differentiated HCC in patients with multiple lesions, since these lesions show higher [18F]FDG uptake.

Cholangiocarcinoma is a neoplasm that arises from the cholangiocyte, the epithelial cells lining the bile ducts. It has an incidence of 1–2 per 100,000 in the western world. The majority of lesions are adenocarcinomas. The first clinical symptom is often painless jaundice. The role of [18F]FDG-PET/CT in these tumors is not clear, since the periductal-infiltrating type may have minimal [18F]FDG uptake, while those that form masses concentrate [18F]FDG. Ampulla of Vater cancer and gallbladder carcinoma are usually associated with masses and are [18F]FDG positive. However, areas of cholangitis may cause false-positive findings. [18F]FDG-PET may have limited value for N staging due to difficulty in separating lymph node lesions from adjacent areas of the primary tumor. On the other hand, [18F]FDG-PET has a high diagnostic value for detecting distant lymph node involvement.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hokkaido University, Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan

    Toshiki Takei MD & Nagara Tamaki MD

  2. Regional Center of Nuclear Medicine, University of Pisa Medical School, Via Roma 55, I-56126, Pisa, Italy

    Giuseppe Boni MD

  3. Department of Radiology, Asahikawa Kosei General Hospital, 1-24, Asahikawa, 078-8211, Japan

    Hiroya Saito MD

  4. Section of Nuclear Medicine, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    H. William Strauss MD

Authors
  1. Toshiki Takei MD
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  2. Giuseppe Boni MD
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  3. Nagara Tamaki MD
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  4. Hiroya Saito MD
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  5. H. William Strauss MD
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Correspondence to Toshiki Takei MD .

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Editors and Affiliations

  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Takei, T., Boni, G., Tamaki, N., Saito, H., Strauss, H.W. (2013). Tumors of the Liver and Biliary Tract. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_16

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